Basic Information
| Provider Information | |||||||||
| NPI: | 1881655645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2312 HANNAH WAY S | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346989453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276417485 | ||||||||
| FaxNumber: | 7277711920 | ||||||||
| Practice Location | |||||||||
| Address1: | 2629 N FOREST RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344425123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525272775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0742 | NH | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC3787 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 3759970 | 01 | FL | CIGNA PROVIDER ID | OTHER | 68155 | 01 | FL | BCBS-FLORIDA PROVIDER ID | OTHER | 7052609 | 01 | FL | AETNA PROVIDER ID | OTHER | 620979300 | 05 | FL | MEDICAID |