MEDICARE: CHANEY EYE CARE, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	17979	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	051555126	OTHER	AL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AL0657	OTHER		EYEMED INSURANCE
4	V01729	OTHER		UPIN
5	051524862	OTHER	AL	BCBS
6	1083763049	OTHER		NPI INDIVIDUAL

General Provider Information

NPI Number	:	1245542927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANEY EYE CARE, L.L.C.

Provider Business Mailing Address
First Line	:	1953 GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3417
Country	:	US
Telephone Number	:	256-845-5555
Fax Number	:	256-997-9310

Provider Business Practice Location Address
First Line	:	1953 GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3417
Country	:	US
Telephone Number	:	256-845-5555
Fax Number	:	256-997-9310

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAD FREEMAN CHANEY
Credential	:	O.D.
Telephone Number	:	256-845-5555

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	07/09/2010

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Directions to “CHANEY EYE CARE, L.L.C. ” Practice Location

Language	Start Address	Practice Location

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