Provider Demographics
NPI:1548990773
Name:MALCOLM, CHLOEE KATHALEEN (OD)
Entity type:Individual
Prefix:DR
First Name:CHLOEE
Middle Name:KATHALEEN
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:559 PROGRESS ST STE D
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9399
Mailing Address - Country:US
Mailing Address - Phone:989-345-8113
Mailing Address - Fax:989-345-7484
Practice Address - Street 1:559 PROGRESS ST STE D
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9399
Practice Address - Country:US
Practice Address - Phone:989-345-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist