Provider Demographics
NPI:1619031549
Name:CHEN, ELIZABETH F (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:CHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:F
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 BALTIC CIR
Mailing Address - Street 2:#511
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-2261
Mailing Address - Country:US
Mailing Address - Phone:408-505-3462
Mailing Address - Fax:
Practice Address - Street 1:1178 EL CAMINO REAL
Practice Address - Street 2:SPACE 265
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2406
Practice Address - Country:US
Practice Address - Phone:650-583-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12950T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08129Medicare UPIN