Individual
TINA CHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 SUMMIT AVE, FORT WORTH, TX 76102-4413
(817) 332-2020
(817) 332-4797
Mailing address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 695-6868
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036.145557
IL
207W00000X
Ophthalmology Physician
125065018
IL
207W00000X
Ophthalmology Physician
Primary
R9737
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401702201
—
TX
Enumeration date
04/02/2014
Last updated
11/22/2021
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