Organization
MALLORY L CHAMBLISS ODPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MALLORY L CHAMBLISS OD (PRESIDENT)
(336) 760-4240
Entity
Organization
Contact information
Practice address
3320 SILAS CREEK PKWY, SUITE 150, WINSTON SALEM, NC 27103-3031
(336) 760-4240
(336) 760-4240
Mailing address
PO BOX 279, RURAL HALL, NC 27045-0279
(336) 760-4240
(336) 760-4240
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0793
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09147
BLUE CROSS BLUE SHIELD
NC
05
—
8909147
—
NC
Enumeration date
03/08/2008
Last updated
08/19/2009
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