Provider Demographics
NPI:1982733101
Name:CLARIZIO, CHANTELLE MARIE (OD)
Entity Type:Individual
Prefix:MS
First Name:CHANTELLE
Middle Name:MARIE
Last Name:CLARIZIO
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 1:1901 W WARNER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2634
Mailing Address - Country:US
Mailing Address - Phone:480-812-2010
Mailing Address - Fax:480-812-1884
Practice Address - Street 1:1901 W WARNER RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2634
Practice Address - Country:US
Practice Address - Phone:480-812-2010
Practice Address - Fax:480-812-1884
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ501826Medicaid
AZ501826Medicaid
Z1355766Medicare PIN