MALLORY L CHAMBLISS ODPA (NPI# 1912177676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912177676 |
| Entity Type | Organization |
| Organization Name | MALLORY L CHAMBLISS ODPA |
| Practice Address |
3320 Silas Creek Pkwy Suite 150 Winston Salem NC 27103-3031 |
| Mailing Address |
Po Box 279 Rural Hall NC 27045-0279 |
| Practice Telephone | 3367604240 |
| Practice Fax Number | 3367604240 |
| Mailing Telephone | 3367604240 |
| Mailing Fax Number | 3367604240 |
| Enumeration Date | 2008-03-08 |
| Last Update Date | 2009-08-19 |
| Authorized Official Name | DR. MALLORY L CHAMBLISS (PRESIDENT) |
| Authorized Official Telephone | 3367604240 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 0793 | NC | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8909147 | 05 | |
| NC | BLUE CROSS BLUE SHIELD | 09147 | 01 |
| Street Address |
3320 SILAS CREEK PKWY SUITE 150 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659330652 | Kelly J Zwiesdak | Optometrist | 3320 Silas Creek Pkwy, Suite 300, Winston Salem, NC 27103-3031 | 2006-03-20 |
| 1881866192 | Jessie Mondestin | Dentist | 3320 Silas Creek Pkwy, Suite 576, Winston Salem, NC 27103-3031 | 2008-03-26 |
| 1336344282 | Deval I Desai | Optometrist | 3320 Silas Creek Pkwy, 300, Winston Salem, NC 27103-3031 | 2007-06-20 |
| 1023132982 | Gary Brent Cogdill | Optometrist | 3320 Silas Creek Pkwy, Suite 280, Winston Salem, NC 27103-3031 | 2007-03-18 |
| 1235286360 | Sonja Ann Osborne | Technician/Technologist | 3320 Silas Creek Pkwy, Suite 150, Winston Salem, NC 27103-3031 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922611342 | Wise Eyes Family Eye Care, Od, Pllc | Optometrist | 631 Coliseum Dr Ste 102, Winston Salem, NC 27106-5310 | 2020-08-25 |
| 1962928556 | Camel City Optometric, P.a. | Optometrist | 604 N Trade St, Winston Salem, NC 27101-2917 | 2017-08-16 |
| 1386027159 | Paul Keith Biggs | Optometrist | 3073 Trenwest Dr # 315, Winston Salem, NC 27103-3207 | 2015-06-29 |
| 1487063400 | Andrew Bradbury | Optometrist | 120 Reynolda Vlg Ste B, Winston Salem, NC 27106-5144 | 2014-08-04 |
| 1225344146 | Lisa Harp Mcallister | Optometrist | 2596 Reynolda Rd Ste A, Winston Salem, NC 27106-4651 | 2010-08-30 |
| 1376865188 | James Kent Doub Od Pa | Optometrist | 2804 Reynolda Rd, Winston Salem, NC 27106-3102 | 2010-02-20 |
| 1558586768 | Jennifer Elizabeth Flaherty | Optometrist | 725 Highland Oaks Dr Ste 101, Winston Salem, NC 27103-7109 | 2007-04-13 |
| 1093837916 | Terry L. Davis | Optometrist | 8013 N Point Blvd, Winston Salem, NC 27106-3203 | 2007-04-03 |
| 1821153230 | Jillian I Okeefe | Optometrist | 302 S Stratford Rd Ste B, Winston Salem, NC 27103-1856 | 2006-12-26 |
| 1508926114 | Winston Salem Optometric Group Pa | Optometrist | 302 South Stratford Road, Winston Salem, NC 27103 | 2006-12-12 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.