Healthcare Provider Details

I. General information

NPI: 1538997598
Provider Name (Legal Business Name): CHANGMIN DUAN OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 STATE ROUTE 18 STE 302
EAST BRUNSWICK NJ
08816-1407
US

IV. Provider business mailing address

190 STATE ROUTE 18 STE 302
EAST BRUNSWICK NJ
08816-1407
US

V. Phone/Fax

Practice location:
  • Phone: 732-247-2847
  • Fax: 732-246-2650
Mailing address:
  • Phone: 732-247-2847
  • Fax: 732-246-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANGMIN DUAN
Title or Position: PRESIDENT
Credential:
Phone: 732-247-2847