Provider Demographics
NPI:1528244902
Name:CHANEY EYE CARE LLC
Entity type:Organization
Organization Name:CHANEY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-845-5555
Mailing Address - Street 1:1953 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3417
Mailing Address - Country:US
Mailing Address - Phone:256-845-5555
Mailing Address - Fax:256-997-9310
Practice Address - Street 1:1953 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3417
Practice Address - Country:US
Practice Address - Phone:256-845-5555
Practice Address - Fax:256-997-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A88-TA-657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5294250001Medicare NSC