Provider Demographics
NPI:1780686774
Name:CHESTER, MICHAEL E (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:CHESTER
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 1:261 N WOODBRIDGE AVE
Mailing Address - Street 2:P.O. BOX 915
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2246
Mailing Address - Country:US
Mailing Address - Phone:740-773-2020
Mailing Address - Fax:740-773-8957
Practice Address - Street 1:261 N WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2246
Practice Address - Country:US
Practice Address - Phone:740-773-2020
Practice Address - Fax:740-773-8957
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3403/T383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400524Medicaid
OH0400524Medicaid
OHT47195Medicare UPIN