Provider Demographics
NPI:1306087184
Name:THOMAS J CHAMBERS OD INC
Entity type:Organization
Organization Name:THOMAS J CHAMBERS OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-447-2143
Mailing Address - Street 1:2845 S STATE ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8974
Mailing Address - Country:US
Mailing Address - Phone:419-447-2143
Mailing Address - Fax:419-447-1595
Practice Address - Street 1:2845 S STATE ROUTE 100
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8974
Practice Address - Country:US
Practice Address - Phone:419-447-2143
Practice Address - Fax:419-447-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2312947Medicaid
OH4330020001Medicare NSC
OH0557422Medicare PIN
OH0557421Medicare PIN