Healthcare Provider Details

I. General information

NPI: 1265690358
Provider Name (Legal Business Name): CLYDE A CHAPMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LINTON BLVD STE C7
DELRAY BEACH FL
33444-1146
US

IV. Provider business mailing address

1100 LINTON BLVD STE C7
DELRAY BEACH FL
33444-1146
US

V. Phone/Fax

Practice location:
  • Phone: 561-278-1116
  • Fax: 561-278-1196
Mailing address:
  • Phone: 561-278-1116
  • Fax: 561-278-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP0002023
License Number StateFL

VIII. Authorized Official

Name: CLYDE ALLEN CHAPMAN
Title or Position: PRESIDENT
Credential: OD
Phone: 561-278-1116