Provider Demographics
NPI:1225230766
Name:CHAMBERLAIN, JAMES DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:463646 STATE ROAD 200
Mailing Address - Street 2:A1A SUITE 12
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0302
Mailing Address - Country:US
Mailing Address - Phone:904-849-7434
Mailing Address - Fax:904-849-7436
Practice Address - Street 1:463646 STATE ROAD 200
Practice Address - Street 2:A1A SUITE 12
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-0302
Practice Address - Country:US
Practice Address - Phone:904-849-7431
Practice Address - Fax:904-849-7436
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC001462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620513501Medicaid
FL620513501Medicaid