Provider Demographics
NPI:1083889497
Name:DANA S CHITWOOD LLC
Entity Type:Organization
Organization Name:DANA S CHITWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-258-8888
Mailing Address - Street 1:60 S STEWART RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4675
Mailing Address - Country:US
Mailing Address - Phone:606-258-8888
Mailing Address - Fax:606-523-5596
Practice Address - Street 1:60 S STEWART RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4675
Practice Address - Country:US
Practice Address - Phone:606-258-8888
Practice Address - Fax:606-523-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1700DT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100025430Medicaid