Provider Demographics
NPI:1770693160
Name:CHIANG, CONNIE S (OD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:S
Last Name:CHIANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7867 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6916
Mailing Address - Country:US
Mailing Address - Phone:954-966-4335
Mailing Address - Fax:954-966-4891
Practice Address - Street 1:7867 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6916
Practice Address - Country:US
Practice Address - Phone:954-966-4335
Practice Address - Fax:954-966-4891
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84179Medicare UPIN
FL19167Medicare PIN
FL19167AMedicare PIN