Provider Demographics
NPI:1245226984
Name:CHADRON VISION CENTER, INC.
Entity Type:Organization
Organization Name:CHADRON VISION CENTER, INC.
Other - Org Name:CHADRON VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHANCELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-432-3222
Mailing Address - Street 1:241 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2301
Mailing Address - Country:US
Mailing Address - Phone:308-432-3222
Mailing Address - Fax:308-432-5344
Practice Address - Street 1:241 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2301
Practice Address - Country:US
Practice Address - Phone:308-432-3222
Practice Address - Fax:308-432-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06923OtherBLUE CROSS BLUE SHIELD
NE09902OtherBLUE CROSS BLUE SHIELD
P00390774OtherRR MEDICARE
SD9203680Medicaid
410017859OtherRR MEDICARE
SD9202140Medicaid
NE06763OtherBLUE CROSS BLUE SHIELD
410046882OtherRR MEDICARE
410046153OtherRR MEDICARE
SD9200910Medicaid
SD9200332Medicaid
410046153OtherRR MEDICARE
NE09902OtherBLUE CROSS BLUE SHIELD
SD9200910Medicaid
NET71366Medicare UPIN
NEE52883Medicare UPIN
SD9200332Medicaid
NE265049Medicare PIN
SD9203680Medicaid
SD9202140Medicaid