MEDICARE: JEFFREY M CHADWICK O D P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003807	MI

General Provider Information

NPI Number	:	1942500160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY M CHADWICK O D P C

Provider Business Mailing Address
First Line	:	325 M-55
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763
Country	:	US
Telephone Number	:	989-362-2754
Fax Number	:	989-362-6231

Provider Business Practice Location Address
First Line	:	325 E M 55
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8211
Country	:	US
Telephone Number	:	989-362-2754
Fax Number	:	989-362-6231

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY MICHAEL CHADWICK
Credential	:	O.D.
Telephone Number	:	989-362-2754

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	11/22/2022

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