Provider Demographics
NPI:1700275153
Name:CHAMBERLAIN, HEATHER C (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:C
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 ST JAMES AVE
Mailing Address - Street 2:STE A5
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2938
Mailing Address - Country:US
Mailing Address - Phone:843-797-5711
Mailing Address - Fax:843-797-5712
Practice Address - Street 1:217 ST JAMES AVE
Practice Address - Street 2:STE A5
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2938
Practice Address - Country:US
Practice Address - Phone:843-797-5711
Practice Address - Fax:843-797-5712
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1097156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician