MEDICARE: SUZETTE CHEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC3556	FL

General Provider Information

NPI Number	:	1396962205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZETTE CHEN O.D.

Provider Business Mailing Address
First Line	:	11382 PROSPERITY FARMS RD
Second Line	:	SUITE 130
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11382 PROSPERITY FARMS RD
Second Line	:	SUITE 130
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3463
Country	:	US
Telephone Number	:	561-622-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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