Provider Demographics
NPI:1407300718
Name:HAWKS, CHELSEY JOHNSON (OD)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:JOHNSON
Last Name:HAWKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 NEW HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7503
Mailing Address - Country:US
Mailing Address - Phone:270-558-4741
Mailing Address - Fax:270-558-4742
Practice Address - Street 1:2559 NEW HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7503
Practice Address - Country:US
Practice Address - Phone:270-558-4741
Practice Address - Fax:270-558-4742
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2029DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist