=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649437302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOE F. CHANEY, JR., OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 W COLLEGE ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71852-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-845-2020
-----------------------------------------------------
Fax | 870-845-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 W COLLEGE ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71852-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-845-2020
-----------------------------------------------------
Fax | 870-845-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOE F CHANEY JR.
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 870-845-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2259
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------