Provider Demographics
NPI:1225016207
Name:CHAMBERS, JOE ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:ALLEN
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:PO BOX 600
Mailing Address - Street 2:510 N MAIN ST
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-0600
Mailing Address - Country:US
Mailing Address - Phone:423-743-3128
Mailing Address - Fax:
Practice Address - Street 1:510 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-0600
Practice Address - Country:US
Practice Address - Phone:423-743-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN494152W00000X
SC422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3593022Medicaid
TN3593022Medicaid
TN3593022Medicare PIN