Provider Demographics
NPI:1164861530
Name:CHANCEY, ANDREA RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENEE
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 207293
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7255
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:2720 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4571
Practice Address - Country:US
Practice Address - Phone:913-651-3344
Practice Address - Fax:913-651-1029
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist