Healthcare Provider Details

I. General information

NPI: 1811153133
Provider Name (Legal Business Name): JEFFREY M CHANIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 OLD COUNTRY RD
PLAINVIEW NY
11803-4917
US

IV. Provider business mailing address

159 EXPRESS ST ATTN: SUSAN AHEARN (DAVIS VISION)
PLAINVIEW NY
11803-2404
US

V. Phone/Fax

Practice location:
  • Phone: 516-681-1161
  • Fax:
Mailing address:
  • Phone: 516-827-6727
  • Fax: 516-733-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007312
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier007312
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: