Provider Demographics
NPI:1174623896
Name:CHASE, R. DONALD (DO)
Entity type:Individual
Prefix:
First Name:R.
Middle Name:DONALD
Last Name:CHASE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SCHOOLEY'S MTN. RD.-RT. 24
Mailing Address - Street 2:HASTINGS SQUARE PLAZA
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-850-4300
Mailing Address - Fax:908-850-5767
Practice Address - Street 1:SCHOOLEY'S MTN. RD.-RT. 24
Practice Address - Street 2:HASTINGS SQUARE PLAZA
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-850-4300
Practice Address - Fax:908-850-5767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05900400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0871610001Medicare NSC
NJCH674960Medicare ID - Type Unspecified
NJE87959Medicare UPIN