MEDICARE: DR. GREGORY WAYNE CHIN 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	OPC 3437	FL

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	:	1588708812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY WAYNE CHIN O.D.

Provider Business Mailing Address
First Line	:	11423 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3311
Country	:	US
Telephone Number	:	305-551-6200
Fax Number	:	305-551-3696

Provider Business Practice Location Address
First Line	:	11423 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3311
Country	:	US
Telephone Number	:	305-551-6200
Fax Number	:	305-551-3696

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	10/01/2023

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