Provider Demographics
NPI:1164115622
Name:CHAMBERLAND, ALEX MATHEW (OD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MATHEW
Last Name:CHAMBERLAND
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 1:633 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5938
Mailing Address - Country:US
Mailing Address - Phone:207-783-8243
Mailing Address - Fax:
Practice Address - Street 1:633 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5938
Practice Address - Country:US
Practice Address - Phone:207-783-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT1069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist