Provider Demographics
NPI:1457417826
Name:CHEN, EDWARD C (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2305 MOHAWK LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1035
Mailing Address - Country:US
Mailing Address - Phone:847-498-3385
Mailing Address - Fax:847-564-3945
Practice Address - Street 1:4171 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2129
Practice Address - Country:US
Practice Address - Phone:847-564-3937
Practice Address - Fax:847-564-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist