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General NPI Number Information
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NPI Number | 1336113794
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Entity Type | Individual
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Provider Name | JESSE CHIN OD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 526 NEWFIELD AVE
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City | STAMFORD
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State | CT
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Zip | 06905-3746
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Country | US
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Telephone | 203-327-1511
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Fax | 203-325-4479
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Provider Business Mailing Address
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Address Line | 526 NEWFIELD AVE
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City | STAMFORD
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State | CT
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Zip | 06905-3746
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Country | US
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Telephone | 203-327-1511
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Fax | 203-325-4479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 002602
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT006536
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License Number State | NY
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