Healthcare Provider Details

I. General information

NPI: 1184245359
Provider Name (Legal Business Name): ERIC RANDALL CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY STE 100
PHOENIX AZ
85054-3106
US

IV. Provider business mailing address

18325 N ALLIED WAY STE 100
PHOENIX AZ
85054-3106
US

V. Phone/Fax

Practice location:
  • Phone: 602-467-4966
  • Fax: 480-419-5401
Mailing address:
  • Phone: 602-467-4966
  • Fax: 480-419-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberU9228
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number326592
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number78039
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: