MEDICARE: CLYDE A CHAPMAN

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	OP0002023	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410026804	OTHER	FL	MEDICARE ID

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

General Provider Information

NPI Number	:	1265690358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLYDE A CHAPMAN

Provider Business Mailing Address
First Line	:	1100 LINTON BLVD STE C7
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-1146
Country	:	US
Telephone Number	:	561-278-1116
Fax Number	:	561-278-1196

Provider Business Practice Location Address
First Line	:	1100 LINTON BLVD STE C7
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-1146
Country	:	US
Telephone Number	:	561-278-1116
Fax Number	:	561-278-1196

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLYDE ALLEN CHAPMAN
Credential	:	OD
Telephone Number	:	561-278-1116

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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