Healthcare Provider Details

I. General information

NPI: 1821373127
Provider Name (Legal Business Name): JULIE EDITH CHEN, O.D. A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 MICHELSON DR STE 110
IRVINE CA
92612-1324
US

IV. Provider business mailing address

2272 MICHELSON DR STE 110
IRVINE CA
92612-1324
US

V. Phone/Fax

Practice location:
  • Phone: 949-851-2015
  • Fax: 888-851-9029
Mailing address:
  • Phone: 949-851-2015
  • Fax: 888-851-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT1113T
License Number StateCA

VIII. Authorized Official

Name: DR. JULIE EDITH CHEN
Title or Position: PRESIDENT
Credential: OD
Phone: 949-545-8431