Provider Demographics
NPI:1144398041
Name:CHIN, LILLIAN F (OD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:F
Last Name:CHIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3739
Mailing Address - Country:US
Mailing Address - Phone:212-219-8896
Mailing Address - Fax:212-219-1263
Practice Address - Street 1:MANHATTAN GRAND OPTICAL
Practice Address - Street 2:203 GRAND STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-219-8896
Practice Address - Fax:212-219-1263
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV04060Medicare UPIN
NYC374E1Medicare ID - Type Unspecified