Provider Demographics
NPI:1831945302
Name:KEN CHEN OPTOMETRY INC
Entity type:Organization
Organization Name:KEN CHEN OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-470-0204
Mailing Address - Street 1:27 COVE RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-7417
Mailing Address - Country:US
Mailing Address - Phone:732-470-0204
Mailing Address - Fax:
Practice Address - Street 1:2202 S SHORE CTR STE F
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5788
Practice Address - Country:US
Practice Address - Phone:510-521-9081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center