Provider Demographics
NPI:1669445763
Name:CHAMBERLAIN, WALTER E JR (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:E
Last Name:CHAMBERLAIN
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2425
Mailing Address - Country:US
Mailing Address - Phone:603-228-1104
Mailing Address - Fax:603-228-7061
Practice Address - Street 1:9 S SPRING ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2425
Practice Address - Country:US
Practice Address - Phone:603-228-1104
Practice Address - Fax:603-228-7061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH976156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician