Provider Demographics
NPI:1700353810
Name:MERCHANT, CHANDNI (OD)
Entity Type:Individual
Prefix:DR
First Name:CHANDNI
Middle Name:
Last Name:MERCHANT
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 1:1028 E ELM TREE RD
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1354
Mailing Address - Country:US
Mailing Address - Phone:719-688-3509
Mailing Address - Fax:
Practice Address - Street 1:2600 LAUREN LN
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-7503
Practice Address - Country:US
Practice Address - Phone:719-688-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty