Provider Demographics
NPI:1447242086
Name:CHAPMAN, MICHAEL K (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
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:P.O. BOX 243
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3858
Mailing Address - Country:US
Mailing Address - Phone:712-262-3331
Mailing Address - Fax:712-262-6885
Practice Address - Street 1:110 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3858
Practice Address - Country:US
Practice Address - Phone:712-262-3331
Practice Address - Fax:712-262-6885
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01457OtherBLUE CROSS/BLUE SHIELD
IA0255307Medicaid
IA109433OtherCOLE MANAGED VISION
IA01457OtherBLUE CROSS/BLUE SHIELD
IA0191990001Medicare NSC
IA01457Medicare PIN