Provider Demographics
NPI:1780756742
Name:CHEN, ANDREW D (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:CHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12091 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1607
Mailing Address - Country:US
Mailing Address - Phone:305-232-3937
Mailing Address - Fax:305-232-3936
Practice Address - Street 1:12091 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1607
Practice Address - Country:US
Practice Address - Phone:305-232-3937
Practice Address - Fax:305-232-3936
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC3220OtherMEDICAL LICENSE