Provider Demographics
NPI:1386728343
Name:CHALFANT, DANIEL (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:CHALFANT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:CHALFANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:1904 W MCGALLIARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2211
Mailing Address - Country:US
Mailing Address - Phone:765-288-1575
Mailing Address - Fax:765-286-5140
Practice Address - Street 1:1904 W MCGALLIARD RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2211
Practice Address - Country:US
Practice Address - Phone:765-288-1575
Practice Address - Fax:765-286-5140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0299700001Medicare ID - Type Unspecified