Provider Demographics
NPI:1285049437
Name:CHADO, SAMUEL (OD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CHADO
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 1:2630 CAMERON WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3049
Mailing Address - Country:US
Mailing Address - Phone:301-896-0890
Mailing Address - Fax:301-896-0968
Practice Address - Street 1:11300 ROCKVILLE PIKE STE 1202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3040
Practice Address - Country:US
Practice Address - Phone:301-896-0890
Practice Address - Fax:301-896-0968
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2581OtherMD OPTOMETRY LICENSE
GAOPT002819OtherGEORGIA MEDICAL LICENSE