Provider Demographics
NPI:1730226762
Name:DAVID G. CHANDLER, O.D.,P.C.
Entity type:Organization
Organization Name:DAVID G. CHANDLER, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:JANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-435-6680
Mailing Address - Street 1:1640 PELHAM RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3312
Mailing Address - Country:US
Mailing Address - Phone:256-435-6680
Mailing Address - Fax:256-435-6705
Practice Address - Street 1:1640 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3312
Practice Address - Country:US
Practice Address - Phone:256-435-6680
Practice Address - Fax:256-435-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058394OtherMEDICARE ID-TYPE UNSPECIFIED
AL000058394Medicaid
AL51058394OtherBLUE CROSS BLUE SHIELD
AL0253220002Medicare NSC
AL000058122Medicare ID - Type Unspecified
AL000058394Medicaid