=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073296273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMBRIE SHAE CHANDLER OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 CHATHAM HEIGHTS RD STE 100
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22405-2593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-371-2777
-----------------------------------------------------
Fax | 540-371-0922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2661 RIVA RD STE 1030
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-7131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-571-8733
-----------------------------------------------------
Fax | 410-571-6309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 00618003324
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------