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General NPI Number Information
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NPI Number | 1689843880
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Entity Type | Organization
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Legal Business Name | IRENE CHEN OD CORP
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 18021 15TH AVE NE STE 100
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City | SHORELINE
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State | WA
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Zip | 98155-3806
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Country | US
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Telephone | 206-367-8883
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55247
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City | SHORELINE
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State | WA
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Zip | 98155-0247
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRENE CHEN
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Credential | OD
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Telephone | 260-351-8610
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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 | 3115
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License Number State | WA
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