Mina Chen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34418TLG Issued in CA

Practice address

157 Petaluma Blvd N
Petaluma, CA 94952-2904

Phone

(707) 285-7475

Fax

(707) 285-7476

NPI assigned

Jun 10, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

State University of New York - State College Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mina Chen OD CorpGroup PAC ID 2264824994, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mina Chen OD Corp

  • Optometrist
  • Petaluma, CA
  • NPI 1942881180
  Medicare reassignment Care Compare group NPD Authorized official
• James E Bruns OD a Professional

  • Point of Service
  • Rohnert Park, CA
  • NPI 1306112362
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1982263265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 CARLSON AVE APT 332",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282801",
            "telephone_number": "510-709-7294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 PETALUMA BLVD N",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522904",
            "telephone_number": "707-285-7475",
            "fax_number": "707-285-7476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "MINA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-10",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV00895701",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34418TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Allen Chappell, M.D.
• Ashley Chavez
• Sunny T Chavez, CNA, MA
• Randell J. Cheek, MFT
• Iun-Iu A. Chen, D.O.
• Richard D Chen, MD
• Lauryn Chenoweth
• Cheryl Cherney, MT
• Derrick Cheroti
• Sebastian Chevrolet

• Optometrist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.