| |
5825 Buford Hwy, Suite 100, Norcross, GA 30071-2545 | |
(770) 448-5587 | |
(770) 448-4086 |
Full Name | |
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Type | Facility |
Speciality | Ophthalmology |
Location | 5825 Buford Hwy, Norcross, Georgia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073753976 | NPI | - | NPPES |
OPT001796 | Other | GA | STATE LICENSE |
OPT002370 | Other | GA | STATE LICENSE |
046583 | Other | GA | STATE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPT002370 (Georgia) | Secondary |
152W00000X | Optometrist | OPT001796 (Georgia) | Secondary |
207W00000X | Ophthalmology | 046583 (Georgia) | Primary |
Provider Name | Willie Y Chen |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1144216631 PECOS PAC ID: 2860574951 Enrollment ID: I20080129000138 |
Mailing Address | Practice Location Address |
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5825 Buford Hwy, Suite 100, Norcross, GA 30071-2545 Ph: (770) 448-5587 | 5825 Buford Hwy, Suite 100, Norcross, GA 30071-2545 Ph: (770) 448-5587 |