Provider Demographics
NPI:1164620217
Name:CHANT, RACHEL M (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:M
Last Name:CHANT
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 1:5831 LANCEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-4919
Mailing Address - Country:US
Mailing Address - Phone:954-663-2105
Mailing Address - Fax:
Practice Address - Street 1:6355 NAPLES BLVD
Practice Address - Street 2:SUITE 1-3
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2070
Practice Address - Country:US
Practice Address - Phone:239-216-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4699152W00000X
TX7058TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006604200Medicaid
FLPTANGN486ZMedicare PIN
FLGN486YMedicare UPIN