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General NPI Number Information
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NPI Number | 1215065727
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Entity Type | Organization
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Legal Business Name | JEFFREY K CHAULK MD PC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 350 W NORTH ST
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City | GAYLORD
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State | MI
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Zip | 49735-1525
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Country | US
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Telephone | 989-732-6455
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Fax | 989-732-1102
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Provider Business Mailing Address
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Address Line | PO BOX 1665
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City | GAYLORD
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State | MI
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Zip | 49734-5665
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Country | US
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Telephone | 989-732-6455
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Fax | 989-732-1102
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY K CHAULK
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Credential | M.D.
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Telephone | 989-732-6455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003939
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 5101016992
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004074
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301405077
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License Number State | MI
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