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General NPI Number Information
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NPI Number | 1245226984
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Entity Type | Organization
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Legal Business Name | CHADRON VISION CENTER, INC.
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 241 E 3RD ST
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City | CHADRON
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State | NE
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Zip | 69337-2301
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Country | US
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Telephone | 308-432-3222
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Fax | 308-432-5344
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Provider Business Mailing Address
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Address Line | 241 E 3RD ST
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City | CHADRON
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State | NE
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Zip | 69337-2301
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Country | US
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Telephone | 308-432-3222
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Fax | 308-432-5344
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Authorized Official
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Title or Position | OWNER / OPTOMETRIST
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Name | TIMOTHY L. CHANCELLOR
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Credential | O.D.
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Telephone | 308-432-3222
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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 |
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License Number State |
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