Provider Demographics
NPI:1538997598
Name:CHANGMIN DUAN OD PA
Entity type:Organization
Organization Name:CHANGMIN DUAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANGMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-247-2847
Mailing Address - Street 1:190 STATE ROUTE 18 STE 302
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1407
Mailing Address - Country:US
Mailing Address - Phone:732-247-2847
Mailing Address - Fax:732-246-2650
Practice Address - Street 1:190 STATE ROUTE 18 STE 302
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1407
Practice Address - Country:US
Practice Address - Phone:732-247-2847
Practice Address - Fax:732-246-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty