Provider Demographics
NPI:1821029299
Name:CHANDLER, DAVID GLENN (OD,PC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GLENN
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:OD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 PELHAM RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3312
Mailing Address - Country:US
Mailing Address - Phone:256-435-6680
Mailing Address - Fax:256-435-6705
Practice Address - Street 1:1640 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3312
Practice Address - Country:US
Practice Address - Phone:256-435-6680
Practice Address - Fax:256-435-6705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS523TA021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058394Medicaid
AL51058394OtherBLUE CROSS BLUE SHIELD
AL000058394Medicaid
AL000058394Medicare PIN
AL0253220002Medicare NSC