Provider Demographics
NPI:1760440739
Name:QIN, CHUAN (OD)
Entity type:Individual
Prefix:DR
First Name:CHUAN
Middle Name:
Last Name:QIN
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 1:2921 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:1663 E HENRIETTA RD
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3121
Practice Address - Country:US
Practice Address - Phone:585-424-7400
Practice Address - Fax:585-424-2643
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0063401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6838Medicare ID - Type Unspecified
U83935Medicare UPIN
NYRA6836Medicare PIN
NYRA6837Medicare PIN