Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV007833 | NY |
NPI | 1003178021 |
---|---|
Provider Name | Dr. Lisa Chen |
First Address | New York, NY 10176-0001 |
Second Address | New York, NY 10176-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 28/11/2018 |