Provider Demographics
NPI:1306991997
Name:CHAMBERS, THOMAS JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000133486OtherANTHEM-HORIZON BLUE CROSS
OH2312947Medicaid
OH0557422Medicare ID - Type Unspecified
OHT48099Medicare UPIN
OH0557421Medicare ID - Type Unspecified
OH000000133486OtherANTHEM-HORIZON BLUE CROSS