Provider Demographics
NPI:1437710498
Name:DEMERLY, CHANLER E (OD)
Entity Type:Individual
Prefix:
First Name:CHANLER
Middle Name:E
Last Name:DEMERLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHANLER
Other - Middle Name:
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-0275
Mailing Address - Country:US
Mailing Address - Phone:765-564-2800
Mailing Address - Fax:
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1327
Practice Address - Country:US
Practice Address - Phone:765-564-2800
Practice Address - Fax:765-564-2477
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004173A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300027794Medicaid