Healthcare Provider Details

I. General information

NPI: 1447205570
Provider Name (Legal Business Name): CHARLES DEMBOWSKI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 POLK ST. SUITE 200
WATERTOWN NY
13601
US

IV. Provider business mailing address

4 COMMERCE LANE
CANTON NY
13617
US

V. Phone/Fax

Practice location:
  • Phone: 315-786-0983
  • Fax:
Mailing address:
  • Phone: 315-386-8191
  • Fax: 315-386-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005520
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOV005520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: