Provider Demographics
NPI:1962203364
Name:CHILNER, MADELYN S (OPTICIAN)
Entity type:Individual
Prefix:MISS
First Name:MADELYN
Middle Name:S
Last Name:CHILNER
Suffix:
Gender:
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7323
Mailing Address - Country:US
Mailing Address - Phone:810-982-6165
Mailing Address - Fax:810-982-6184
Practice Address - Street 1:1237 32ND ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-7323
Practice Address - Country:US
Practice Address - Phone:810-982-6165
Practice Address - Fax:810-982-6184
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI258735156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician