Provider Demographics
NPI:1881383214
Name:GUAN, MEIZHEN
Entity type:Individual
Prefix:
First Name:MEIZHEN
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4015
Mailing Address - Country:US
Mailing Address - Phone:917-651-6870
Mailing Address - Fax:718-699-8197
Practice Address - Street 1:8327 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5716
Practice Address - Country:US
Practice Address - Phone:718-699-8197
Practice Address - Fax:718-699-8197
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009017156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician