MEDICARE: DR. MICHAEL D CHESEN O.D.

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	OPC2746	FL

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	:	1619076692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D CHESEN O.D.

Provider Business Mailing Address
First Line	:	2909 SW 160 AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4212
Country	:	US
Telephone Number	:	954-437-9733
Fax Number	:	954-432-6116

Provider Business Practice Location Address
First Line	:	2909 SW 160 AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4212
Country	:	US
Telephone Number	:	954-437-9733
Fax Number	:	954-432-6116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/13/2017

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