Individual
MR. KYLE CHAMBLISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
2080 N BLACK HORSE PIKE, WILLIAMSTOWN, NJ 08094-9128
(856) 875-7042
Mailing address
239 N 54TH ST, PHILADELPHIA, PA 19139-2002
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
31TD00380800
NJ
Other
Enumeration date
05/26/2023
Last updated
05/26/2023
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