Provider Demographics
NPI:1790756468
Name:ISON CHATFIELD, ANNA L (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:ISON CHATFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2443
Mailing Address - Country:US
Mailing Address - Phone:508-226-3330
Mailing Address - Fax:508-226-6200
Practice Address - Street 1:160 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2443
Practice Address - Country:US
Practice Address - Phone:508-226-3330
Practice Address - Fax:508-226-6200
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392138Medicaid
MA0392138Medicaid
W15957Medicare ID - Type Unspecified