Provider Demographics
NPI:1053337154
Name:POOLE, CHAD EDGAR (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EDGAR
Last Name:POOLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 GAINES SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3132
Mailing Address - Country:US
Mailing Address - Phone:706-850-7101
Mailing Address - Fax:706-850-7089
Practice Address - Street 1:850 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3132
Practice Address - Country:US
Practice Address - Phone:706-850-7101
Practice Address - Fax:706-850-7089
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109146CMedicaid