MEDICARE: MARY N. CHASE, O.D., PLLC

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

General Provider Information

NPI Number	:	1891390605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY N. CHASE, O.D., PLLC

Provider Business Mailing Address
First Line	:	1042 E TRI COUNTY BLVD
Second Line	:
City	:	OLIVER SPRINGS
State	:	TN
Zip	:	37840-6205
Country	:	US
Telephone Number	:	865-435-1513
Fax Number	:	865-435-1513

Provider Business Practice Location Address
First Line	:	1042 E TRI COUNTY BLVD
Second Line	:
City	:	OLIVER SPRINGS
State	:	TN
Zip	:	37840-6205
Country	:	US
Telephone Number	:	865-435-1513
Fax Number	:	865-730-6005

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. MARY NETHAWAY CHASE
Credential	:	OD
Telephone Number	:	865-435-1513

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/20/2023

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