Chad Eldon Willis, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3023 Issued in CO

Practice address

113 Lielmanis Ave
Hurlburt Field, FL 32544-5613

Phone

(850) 881-3918

NPI assigned

Jan 18, 2006

Last updated

Apr 6, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522972800000",
    "number": "1114907185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-881-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-881-3918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "559 Vincent St",
            "address_2": "21 AMDS/SGPE- ATTN: Optometry",
            "address_purpose": "LOCATION",
            "city": "Peterson AFB",
            "state": "CO",
            "postal_code": "809141540",
            "country_code": "US",
            "telephone_number": "719-556-1065",
            "fax_number": "866-867-7926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CHAD",
        "middle_name": "ELDON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2018-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02329",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "3023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0470674",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLLMARK BCBS",
            "identifier": "00864",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Todd Wentworth, IDMT
• Nicole Katherine White, RD, CSSD, LDN
• Lawrence Allen Whitmore, IDMT
• Joseph Harold Williams III, IDMT
• Laura Williams, APRN
• Kimberly Joy Woideck, O.D.
• Christopher Colin Wolper
• Daniel Wood, DDS
• Scott David Wright, DMD
• Daniel Owen Wyman, MD, MPH

• Optometrist in Hurlburt Field, FL
• Providers in Hurlburt Field, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.