Provider Demographics
NPI:1497831937
Name:CHADWELL, CHARLES D (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:CHADWELL
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 1:428 N CARLISLE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1775
Mailing Address - Country:US
Mailing Address - Phone:256-894-5955
Mailing Address - Fax:
Practice Address - Street 1:428 N CARLISLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1775
Practice Address - Country:US
Practice Address - Phone:256-894-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-568-TA-269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT61283Medicare UPIN