Healthcare Provider Details

I. General information

NPI: 1245887975
Provider Name (Legal Business Name): AMANDA RAYE CHAMBERLIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14905 PARAMOUNT BLVD STE E
PARAMOUNT CA
90723-3440
US

IV. Provider business mailing address

14905 PARAMOUNT BLVD STE E
PARAMOUNT CA
90723-3440
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-6046
  • Fax: 562-633-0260
Mailing address:
  • Phone: 562-633-6046
  • Fax: 562-633-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9717TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: