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General NPI Number Information
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NPI Number | 1124200894
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Entity Type | Organization
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Legal Business Name | GREGORY W CHIN O D P A
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 11455 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3311
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Country | US
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Telephone | 305-551-6200
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Fax | 305-551-3696
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Provider Business Mailing Address
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Address Line | 11455 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3311
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Country | US
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Telephone | 305-551-6200
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Fax | 305-551-3696
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. GREGORY WAYNE CHIN
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Credential | O.D.
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Telephone | 305-551-6200
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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 | OPC 3437
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License Number State | FL
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