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General NPI Number Information
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NPI Number | 1649917931
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Entity Type | Organization
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Legal Business Name | DR EMELLINE CHEN OD OPTOMETRIC CORP
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 36330 HIDDEN SPRINGS RD STE A
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City | WILDOMAR
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State | CA
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Zip | 92595-5804
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Country | US
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Telephone | 909-632-8416
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Fax |
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Provider Business Mailing Address
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Address Line | 15800 EL PRADO RD STE B
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City | CHINO
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State | CA
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Zip | 91708-9122
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Country | US
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Telephone | 909-632-3819
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. EMELLINE CHEN
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Credential | OD
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Telephone | 951-609-9099
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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 |
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License Number State |
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