MEDICARE: DR. ELZIE C. CHAN-ENGLENDER 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	TPOP17	FL
2	152W00000X	Optometrist	21313-875	WI
3	152W00000X	Optometrist	T006563-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508860065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELZIE C. CHAN-ENGLENDER O.D.

Provider Business Mailing Address
First Line	:	107-20 71ST CONTINENTAL AVENUE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-0000
Country	:	US
Telephone Number	:	718-544-2200
Fax Number	:	718-544-2102

Provider Business Practice Location Address
First Line	:	107-20 71ST CONTINENTAL AVENUE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-0000
Country	:	US
Telephone Number	:	718-544-2200
Fax Number	:	718-544-2102

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

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	03/06/2022

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Directions to “ DR. ELZIE C. CHAN-ENGLENDER O.D.” Practice Location

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