Healthcare Provider Details

I. General information

NPI: 1295132520
Provider Name (Legal Business Name): JINGYA JEANNE CHEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HIGHWOODS BLVD
GREENSBORO NC
27410-2048
US

IV. Provider business mailing address

3316 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3011
US

V. Phone/Fax

Practice location:
  • Phone: 336-297-4731
  • Fax: 336-297-4736
Mailing address:
  • Phone: 336-765-5350
  • Fax: 336-765-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2406
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: