Most Relevant Information
Provider Data
| NPI Number: | 1003580762 |
| Provider Name: | IAN MATTHEW CHESLOCK |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | 61169322 |
Most Important Dates
| Enumeration Date: | 08/05/2021 |
| Last Updated: | 08/05/2021 |
Provider Practice Location
950 11TH AVE
LONGVIEW
WA
986322504
Practice Location Phone/Fax
| Phone: | 3605771500 |
| Fax: | 3604250735 |
Provider Mailing Location
950 11TH AVE
LONGVIEW
WA
986322504
Provider Mailing Phone/Fax
| Phone: | 3605771500 |
| Fax: | 3604250735 |