Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 535 | SC |
NPI | 1063536142 |
---|---|
Provider Name | Mrs. Vicki W Chamberlain |
First Address | Goose Creek, SC 29445 |
Second Address | Goose Creek, SC 29445-2938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DV5352 | (05) | SC |