=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639996689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIA YU CHEN, O.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2024
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45-1123 KAMEHAMEHA HWY STE 201
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-247-6696
-----------------------------------------------------
Fax | 808-247-6665
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45-1123 KAMEHAMEHA HWY STE 201
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-247-6696
-----------------------------------------------------
Fax | 808-247-6665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | CHIA YU CHEN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 808-247-6696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------