Healthcare Provider Details

I. General information

NPI: 1437151719
Provider Name (Legal Business Name): CHARLES J BREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY RD STE 300
FLORENCE KY
41042-4895
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-746-1990
  • Fax: 859-746-3149
Mailing address:
  • Phone: 859-746-1990
  • Fax: 859-746-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number30914
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.067760
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-06-7760-B
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30914
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: