Provider Demographics
NPI:1891292959
Name:CHAUNCEY EYE GROUP LLC
Entity Type:Organization
Organization Name:CHAUNCEY EYE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:610-586-0651
Mailing Address - Street 1:30 S MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1725
Mailing Address - Country:US
Mailing Address - Phone:610-586-0651
Mailing Address - Fax:610-586-0652
Practice Address - Street 1:30 SOUTH MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1725
Practice Address - Country:US
Practice Address - Phone:610-586-0651
Practice Address - Fax:610-586-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty