Healthcare Provider Details

I. General information

NPI: 1730522830
Provider Name (Legal Business Name): JOEL ERIC CHASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8679 CONNECTICUT STREET SUITE A
MERRILLVILLE IN
46410-6383
US

IV. Provider business mailing address

8679 CONNECTICUT STREET SUITE A
MERRILLVILLE IN
46410-6383
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-9022
  • Fax: 219-649-2995
Mailing address:
  • Phone: 219-769-9022
  • Fax: 219-649-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0058598
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036150656
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01082893A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: