Healthcare Provider Details

I. General information

NPI: 1821029299
Provider Name (Legal Business Name): DAVID GLENN CHANDLER O.D.,PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 PELHAM RD S
JACKSONVILLE AL
36265-3312
US

IV. Provider business mailing address

1640 PELHAM RD S
JACKSONVILLE AL
36265-3312
US

V. Phone/Fax

Practice location:
  • Phone: 256-435-6680
  • Fax: 256-435-6705
Mailing address:
  • Phone: 256-435-6680
  • Fax: 256-435-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS523TA021
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: