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General NPI Number Information
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NPI Number | 1932530755
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Entity Type | Organization
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Legal Business Name | CHAMBERLAIN CORP
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 1480 SADLER RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4426
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Country | US
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Telephone | 904-432-8168
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16732
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City | FERNANDINA BEACH
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State | FL
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Zip | 32035-3129
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Country | US
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Telephone | 904-432-8168
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES DANIEL CHAMBERLAIN
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Credential | O.D.
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Telephone | 904-206-4378
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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 | OPC1462
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License Number State | FL
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