MEDICARE: MR. DAVID GLENN CHANDLER O.D.,PC

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	S523TA021	AL

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
2	51058394	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1821029299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID GLENN CHANDLER O.D.,PC

Provider Business Mailing Address
First Line	:	1640 PELHAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-435-6680
Fax Number	:	256-435-6705

Provider Business Practice Location Address
First Line	:	1640 PELHAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-435-6680
Fax Number	:	256-435-6705

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/07/2026

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