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General NPI Number Information
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NPI Number | 1245542927
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Entity Type | Organization
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Legal Business Name | CHANEY EYE CARE, L.L.C.
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1953 GAULT AVE N
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City | FORT PAYNE
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State | AL
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Zip | 35967-3417
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Country | US
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Telephone | 256-845-5555
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Fax | 256-997-9310
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Provider Business Mailing Address
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Address Line | 1953 GAULT AVE N
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City | FORT PAYNE
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State | AL
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Zip | 35967-3417
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Country | US
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Telephone | 256-845-5555
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Fax | 256-997-9310
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD FREEMAN CHANEY
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Credential | O.D.
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Telephone | 256-845-5555
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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 | 17979
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License Number State | AL
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