Provider Demographics
NPI:1932968336
Name:MCDUFFIE, CHAD SHAWNTAL (LDO)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:SHAWNTAL
Last Name:MCDUFFIE
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:SHAWNTAL
Other - Last Name:MCDUFFIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDO
Mailing Address - Street 1:731 E ROCHAMBEAU DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2187
Mailing Address - Country:US
Mailing Address - Phone:757-220-8548
Mailing Address - Fax:
Practice Address - Street 1:731 E ROCHAMBEAU DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2187
Practice Address - Country:US
Practice Address - Phone:757-220-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003093156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician