Healthcare Provider Details

I. General information

NPI: 1265552616
Provider Name (Legal Business Name): CHARLES H COLE OD & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 FRONTAGE RD
WARSAW IN
46580-3914
US

IV. Provider business mailing address

2934 FRONTAGE RD
WARSAW IN
46580-3914
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-5558
  • Fax: 574-269-3088
Mailing address:
  • Phone: 574-269-5558
  • Fax: 574-269-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002042B
License Number StateIN

VIII. Authorized Official

Name: DR. CHARLES H. COLE
Title or Position: OWNER
Credential: OD
Phone: 574-269-5558