Provider Demographics
NPI:1396033346
Name:CHATHAM, KALEY HARDESTY (OD)
Entity type:Individual
Prefix:DR
First Name:KALEY
Middle Name:HARDESTY
Last Name:CHATHAM
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 1:233 WILLIAMSBURG SQ
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6473
Mailing Address - Country:US
Mailing Address - Phone:270-684-3234
Mailing Address - Fax:
Practice Address - Street 1:233 WILLIAMSBURG SQ
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6473
Practice Address - Country:US
Practice Address - Phone:270-684-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1839DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100171400Medicaid