Provider Demographics
NPI:1750345369
Name:FELLOWS, CHAD KAY (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:KAY
Last Name:FELLOWS
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 1:218 LOWER MOUNTAIN VIEW DR STE 2
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8111
Mailing Address - Country:US
Mailing Address - Phone:802-654-7599
Mailing Address - Fax:802-654-7592
Practice Address - Street 1:218 LOWER MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5830
Practice Address - Country:US
Practice Address - Phone:802-654-7599
Practice Address - Fax:802-654-7592
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4760909152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
VT030.0059291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005573501Medicare ID - Type UnspecifiedSANDY
UT005573601Medicare ID - Type UnspecifiedDRAPER
UTU80663Medicare UPIN