Healthcare Provider Details

I. General information

NPI: 1063375665
Provider Name (Legal Business Name): STEVEN CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 US-280 E
BIRMINGHAM AL
35242
US

IV. Provider business mailing address

100 WILDOAK DR
IRONDALE AL
35210-2621
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-4069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F77
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: