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General NPI Number Information
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NPI Number | 1083863161
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Entity Type | Organization
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Legal Business Name | CHEN EYE CENTER JOHNS CREEK
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 6325 HOSPITAL PKWY SUITE 115
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City | JOHNS CREEK
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State | GA
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Zip | 30097-5775
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Country | US
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Telephone | 770-948-3070
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Fax | 678-475-0504
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Provider Business Mailing Address
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Address Line | 6335 HOSPITAL PKWY SUITE 115
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1549
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Country | US
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Telephone | 770-448-4487
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Fax | 678-475-0504
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Authorized Official
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Title or Position | CEO
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Name | WILLIE Y W CHEN
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Credential | MD
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Telephone | 770-448-5587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002370
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 046583
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License Number State | GA
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