Healthcare Provider Details

I. General information

NPI: 1548484538
Provider Name (Legal Business Name): JULIE E CHEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
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

2030 MAIN ST SUITE 115
IRVINE CA
92614-7219
US

V. Phone/Fax

Practice location:
  • Phone: 949-545-8431
  • Fax: 888-851-9029
Mailing address:
  • Phone: 949-851-2015
  • Fax: 888-851-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT11113TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT11113TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: