Kyle Chambliss, LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

31TD00380800 Issued in NJ

Practice address

2080 N Black Horse Pike
Williamstown, NJ 08094-9128

Phone

(856) 875-7042

NPI assigned

May 26, 2023

Last updated

May 26, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1336832369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 N 54TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191392002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 N BLACK HORSE PIKE",
            "city": "WILLIAMSTOWN",
            "state": "NJ",
            "postal_code": "080949128",
            "telephone_number": "856-875-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMBLISS",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "credential": "LDO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-26",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NJ",
            "license": "31TD00380800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Marie Cavanaugh, RPH
• Center for Family Services
• Center for Family Services, Inc.
• Center for Family Services, Inc.
• Debra Chalk, RN, IBCLC, CPD
• Manmohit Chawla, RN
• Allison Marie Chiardio, RRT
• Atin Chopra, PHARM D
• Clean Pathways LLC
• Clinton Baney DC LLC

• Optician in Williamstown, NJ
• Providers in Williamstown, NJ by specialty
• Optician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.