Provider Demographics
NPI:1184073033
Name:CHANDLER, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 ACTON LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3689
Mailing Address - Country:US
Mailing Address - Phone:724-664-6784
Mailing Address - Fax:
Practice Address - Street 1:10660 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3432
Practice Address - Country:US
Practice Address - Phone:703-369-3937
Practice Address - Fax:703-369-7147
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist