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General NPI Number Information
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NPI Number | 1124260401
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Entity Type | Organization
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Legal Business Name | CW VISION OPTICAL, INC.
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 463646 S.R. 200 A1A SUITE 12
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City | YULEE
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State | FL
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Zip | 32097-0303
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Country | US
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Telephone | 904-849-7431
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Fax | 904-849-7436
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Provider Business Mailing Address
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Address Line | 463646 SR 200 A1A SUITE 12
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City | YULEE
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State | FL
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Zip | 32097
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Country | US
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Telephone | 904-849-7431
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Fax | 904-849-7436
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES D. CHAMBERLAIN
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Credential | O.D.
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Telephone | 904-849-7431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC0001462
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License Number State | FL
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