Provider Demographics
NPI:1295702264
Name:DUAN, CHANGMIN (OD)
Entity type:Individual
Prefix:
First Name:CHANGMIN
Middle Name:
Last Name:DUAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 STATE ROUTE 18 STE 107
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1913
Mailing Address - Country:US
Mailing Address - Phone:732-247-2847
Mailing Address - Fax:732-246-2650
Practice Address - Street 1:223 STATE ROUTE 18 STE 107
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1913
Practice Address - Country:US
Practice Address - Phone:732-247-2847
Practice Address - Fax:732-246-2650
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 05333152W00000X
NYU00558-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU52085Medicare UPIN
NJDU575956Medicare ID - Type Unspecified