Provider Demographics
NPI:1215012166
Name:CHAPMAN, JAY M (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 S LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3707
Mailing Address - Country:US
Mailing Address - Phone:931-762-1364
Mailing Address - Fax:931-762-1371
Practice Address - Street 1:234 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3707
Practice Address - Country:US
Practice Address - Phone:931-762-1364
Practice Address - Fax:931-762-1371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU01741Medicare UPIN
TN3592766Medicare PIN
TN0746940001Medicare NSC