Provider Demographics
NPI:1528196193
Name:CHANCE, DEBORAH (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:CHANCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:CHANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:475 CROCKETT TRACE DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-587-2929
Mailing Address - Fax:
Practice Address - Street 1:475 SOUTH DAVY CROCKETT
Practice Address - Street 2:SUITE 2
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-587-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528196193Medicare UPIN
3941933Medicare ID - Type Unspecified