| Name: | David G. Chandler, O.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 Dec 1983 (41 years ago) |
| Entity Number: | 000-095-685 |
| Register Number: | 000095685 |
| Place of Formation: | Etowah County |
| Principal Address: | GADSDEN, AL |
| Registered Office Street Address: | ROUTE 7 BOX 459AGADSDEN, AL |
| Authorized Capital: | $1,000 |
Activities
OPTOMETRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730226762 | 2007-01-31 | 2012-09-12 | 1640 PELHAM RD S, JACKSONVILLE, AL, 362653312, US | 1640 PELHAM RD S, JACKSONVILLE, AL, 362653312, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 256-435-6680 |
| Fax | 2564356705 |
Authorized person
| Name | JANN TROUP |
| Role | BILLING CLERK |
| Phone | 2564356680 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-523 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE ID-TYPE UNSPECIFIED |
| Number | 000058394 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000058394 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51058394 |
| State | AL |
| Name | Role |
|---|---|
| CHANDLER, DAVID G | Agent |
| Name | Role |
|---|---|
| CHANDLER, DAVID G | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
