Healthcare Provider Details

I. General information

NPI: 1255351961
Provider Name (Legal Business Name): WEN Y CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MAIN ST
EAST ALTON IL
62024-1173
US

IV. Provider business mailing address

200 W MAIN ST
EAST ALTON IL
62024-1173
US

V. Phone/Fax

Practice location:
  • Phone: 618-259-0440
  • Fax: 618-258-4362
Mailing address:
  • Phone: 618-259-0440
  • Fax: 618-258-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-079700
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: