Individual
MR. TIMOTHY LEE CHANCELLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
241 E 3RD ST, CHADRON, NE 69337-2301
(308) 432-3222
(308) 432-5344
Mailing address
241 E 3RD ST, CHADRON, NE 69337-2301
(308) 432-3222
(308) 432-5344
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1051
NE
152W00000X
Optometrist
621
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06923
BCBS
NE
01
—
410046153
RR MEDICARE
—
01
—
4993076
WELLMARK BCBS
SD
05
—
9200330
—
SD
05
—
9200332
—
SD
05
—
9200333
—
SD
Enumeration date
03/20/2006
Last updated
01/12/2024
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