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:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-2261
Mailing Address - Country:US
Mailing Address - Phone:989-426-8272
Mailing Address - Fax:
Practice Address - Street 1:202 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-2261
Practice Address - Country:US
Practice Address - Phone:989-426-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-11
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist