Provider Demographics
NPI:1265690358
Name:CLYDE A CHAPMAN
Entity Type:Organization
Organization Name:CLYDE A CHAPMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-278-1116
Mailing Address - Street 1:1100 LINTON BLVD STE C7
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1146
Mailing Address - Country:US
Mailing Address - Phone:561-278-1116
Mailing Address - Fax:561-278-1196
Practice Address - Street 1:1100 LINTON BLVD STE C7
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1146
Practice Address - Country:US
Practice Address - Phone:561-278-1116
Practice Address - Fax:561-278-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078531801Medicaid
FL410026804OtherMEDICARE ID
FL410026804OtherMEDICARE ID
FL078531801Medicaid
FL19952Medicare PIN