Healthcare Provider Details

I. General information

NPI: 1902830458
Provider Name (Legal Business Name): DONNA M CHANEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MADISON AVE
MADISON WV
25130-1511
US

IV. Provider business mailing address

PO BOX 86
MADISON WV
25130-0086
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-0632
  • Fax: 304-369-0633
Mailing address:
  • Phone: 304-369-0632
  • Fax: 304-369-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number864OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: