Provider Demographics
NPI:1528081049
Name:CHESEN, RICHARD JAY (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:CHESEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4212
Mailing Address - Country:US
Mailing Address - Phone:954-437-9733
Mailing Address - Fax:954-432-6116
Practice Address - Street 1:2909 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4212
Practice Address - Country:US
Practice Address - Phone:954-437-9733
Practice Address - Fax:954-432-6116
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003876300Medicaid
19241XMedicare PIN
FLT84133Medicare UPIN