MEDICARE: DR. MARY ELIZABETH CHENAULT 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	S-D01-TA-949	AL

General Provider Information

NPI Number	:	1851723258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH CHENAULT O.D.

Provider Business Mailing Address
First Line	:	741 PLUMMER RD
Second Line	:	APARTMENT 401
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-3815
Country	:	US
Telephone Number	:	256-772-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 INTERCOM DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2638
Country	:	US
Telephone Number	:	256-772-2929
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	09/25/2013

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