Provider Demographics
NPI:1093236416
Name:DEVITT, CHELSEA ANNE (OD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANNE
Last Name:DEVITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WELLS BRANCH PKWY APT 5304
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6693
Mailing Address - Country:US
Mailing Address - Phone:330-805-0999
Mailing Address - Fax:
Practice Address - Street 1:3410 FAR WEST BLVD STE 140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3167
Practice Address - Country:US
Practice Address - Phone:404-531-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003039152W00000X
TX9600TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist