Provider Demographics
NPI:1982794525
Name:CHEN, SIMON (OD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
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 1:1237 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1718
Mailing Address - Country:US
Mailing Address - Phone:714-983-7088
Mailing Address - Fax:714-983-7263
Practice Address - Street 1:1237 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1718
Practice Address - Country:US
Practice Address - Phone:714-983-7088
Practice Address - Fax:714-983-7263
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12755-T152W00000X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy