Provider Demographics
NPI:1316291206
Name:MAHAFFEY, CHAD DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DANIEL
Last Name:MAHAFFEY
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 1:217 FORECASTLE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9268
Mailing Address - Country:US
Mailing Address - Phone:865-985-9092
Mailing Address - Fax:
Practice Address - Street 1:189 HARBISON BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2215
Practice Address - Country:US
Practice Address - Phone:803-223-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT2182152W00000X
FLOPC4755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist