Provider Demographics
NPI:1801833090
Name:CHAPMAN, CLYDE A (OD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:A
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1100 LINTON BLVD
Practice Address - Street 2:STE C7
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1149
Practice Address - Country:US
Practice Address - Phone:561-278-1116
Practice Address - Fax:561-278-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078531801Medicaid
FLT93961Medicare UPIN
FL078531801Medicaid
FL0900560001Medicare NSC
FL078531801Medicaid