Provider Demographics
NPI:1033113972
Name:CHAFIN, WILLIAM ROBERT III (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:CHAFIN
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 S GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1836
Mailing Address - Country:US
Mailing Address - Phone:806-359-3956
Mailing Address - Fax:806-355-6907
Practice Address - Street 1:2303 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1836
Practice Address - Country:US
Practice Address - Phone:806-359-3956
Practice Address - Fax:806-355-6907
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX3162TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019922601Medicaid
TX0051LMedicare ID - Type UnspecifiedMEDICARE
TX019922601Medicaid