MEDICARE: CHADRON VISION CENTER, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972533354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHADRON VISION CENTER, INC.

Provider Business Mailing Address
First Line	:	112 N MAIN ST
Second Line	:
City	:	GORDON
State	:	NE
Zip	:	69343-1524
Country	:	US
Telephone Number	:	308-282-0820
Fax Number	:	308-282-0833

Provider Business Practice Location Address
First Line	:	112 N MAIN ST
Second Line	:
City	:	GORDON
State	:	NE
Zip	:	69343-1524
Country	:	US
Telephone Number	:	308-282-0820
Fax Number	:	308-282-0833

Authorized Official
Title or Position	:	OWNER / OPTOMETRIST
Name	:	DR. JOSEPH L. SHETLER
Credential	:	O.D.
Telephone Number	:	308-282-0820

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/06/2011

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Directions to “CHADRON VISION CENTER, INC. ” Practice Location

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