MEDICARE: THOMAS J CHAMBERS OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3764	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306087184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS J CHAMBERS OD INC

Provider Business Mailing Address
First Line	:	2845 S STATE ROUTE 100
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8974
Country	:	US
Telephone Number	:	419-447-2143
Fax Number	:	419-447-1595

Provider Business Practice Location Address
First Line	:	2845 S STATE ROUTE 100
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8974
Country	:	US
Telephone Number	:	419-447-2143
Fax Number	:	419-447-1595

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS J CHAMBERS
Credential	:	O.D.
Telephone Number	:	419-447-2143

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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