=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265585426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANGMIN DUAN OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 03/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 STATE ROUTE 18 STE 107
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-247-2847
-----------------------------------------------------
Fax | 732-246-2650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 STATE ROUTE 18
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-247-2847
-----------------------------------------------------
Fax | 732-246-2650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHANGMIN DUAN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 732-247-2847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OA05333
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------