Individual
DR. CHAD ELDON WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 881-3918
Mailing address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 881-3918
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
02329
IA
152W00000X
Optometrist
Primary
3023
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00864
WELLLMARK BCBS
IA
05
—
0470674
—
IA
Enumeration date
01/18/2006
Last updated
04/06/2018
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