Provider Demographics
NPI:1487056073
Name:PELLOW, CHASE D
Entity type:Individual
Prefix:MR
First Name:CHASE
Middle Name:D
Last Name:PELLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-883-9550
Mailing Address - Fax:716-883-9551
Practice Address - Street 1:902 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-883-9550
Practice Address - Fax:716-883-9551
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008727-1156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens