Provider Demographics
NPI:1811153133
Name:CHANIN, JEFFREY M (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:CHANIN
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 1:159 EXPRESS ST
Mailing Address - Street 2:ATTN: SUSAN AHEARN (DAVIS VISION)
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2404
Mailing Address - Country:US
Mailing Address - Phone:516-827-6727
Mailing Address - Fax:516-733-5508
Practice Address - Street 1:1004 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4917
Practice Address - Country:US
Practice Address - Phone:516-681-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007312OtherLICENCE