Healthcare Provider Details

I. General information

NPI: 1215909643
Provider Name (Legal Business Name): CHAD EVERETT MCDONALD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 LOW ST
NEWBURYPORT MA
01950-4048
US

IV. Provider business mailing address

33 LOW ST
NEWBURYPORT MA
01950-4048
US

V. Phone/Fax

Practice location:
  • Phone: 978-462-2020
  • Fax: 978-462-4263
Mailing address:
  • Phone: 978-462-2020
  • Fax: 978-462-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4087
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: