Healthcare Provider Details

I. General information

NPI: 1154319366
Provider Name (Legal Business Name): CHARLES R DESCHENEAUX OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 PEGASUS DR
ORLANDO FL
32816-8030
US

IV. Provider business mailing address

2984 ALAFAYA TRL #1030
OVIEDO FL
32765-7628
US

V. Phone/Fax

Practice location:
  • Phone: 407-365-4040
  • Fax:
Mailing address:
  • Phone: 407-365-4040
  • Fax: 407-365-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: