MEDICARE: CHANEY EYE CARE LLC

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	S-A88-TA-657	AL

General Provider Information

NPI Number	:	1528244902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANEY EYE CARE LLC

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/DOCTOR OF OPTOMETRY
Name	:	DR. CHAD FREEMAN CHANEY
Credential	:	O.D.
Telephone Number	:	256-845-5555

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	11/27/2012

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