Healthcare Provider Details

I. General information

NPI: 1922595636
Provider Name (Legal Business Name): PAUL DAVID CHAMBERLAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

2636 W SUGAR CREST DR
EAGLE ID
83616-6758
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3020
  • Fax:
Mailing address:
  • Phone: 208-608-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12667018-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2026-03305
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: