Provider Demographics
NPI:1922042944
Name:CHANDLER, JEFF L (OD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:L
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5915
Mailing Address - Country:US
Mailing Address - Phone:937-435-8605
Mailing Address - Fax:937-435-6801
Practice Address - Street 1:125 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-5915
Practice Address - Country:US
Practice Address - Phone:937-435-8605
Practice Address - Fax:937-435-6801
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE9354061Medicare ID - Type Unspecified
T47474Medicare UPIN
OH5437570001Medicare NSC