Provider Demographics
NPI:1083763049
Name:CHANEY, CHAD FREEMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:FREEMAN
Last Name:CHANEY
Suffix:
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 1:1953 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3417
Mailing Address - Country:US
Mailing Address - Phone:256-845-5555
Mailing Address - Fax:256-997-9310
Practice Address - Street 1:1953 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3417
Practice Address - Country:US
Practice Address - Phone:256-845-5555
Practice Address - Fax:256-997-9310
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A88-TA-657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5294250001OtherPALMETTO GBA-DMERC
ALAL0657OtherEYECARE PLAN OF AMERICA
ALV01729Medicare UPIN