Provider Demographics
NPI:1902830458
Name:CHANEY, DONNA M (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:CHANEY
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-0086
Mailing Address - Country:US
Mailing Address - Phone:304-369-0632
Mailing Address - Fax:304-369-0633
Practice Address - Street 1:300 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1511
Practice Address - Country:US
Practice Address - Phone:304-369-0632
Practice Address - Fax:304-369-0633
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV864OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710426OtherBLUE CROSS BLUE SHIELD
WV0149448000Medicaid
410041380OtherRAILROAD MEDICARE
0506510002Medicare NSC
WV0149448000Medicaid
0662057Medicare ID - Type Unspecified