Healthcare Provider Details

I. General information

NPI: 1457463275
Provider Name (Legal Business Name): CYNTHIA G CHARNETSKI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 PEMBROKE DR STE 100
HILTON HEAD ISLAND SC
29926-6200
US

IV. Provider business mailing address

PO BOX 117556
ATLANTA GA
30368-7556
US

V. Phone/Fax

Practice location:
  • Phone: 843-785-2525
  • Fax: 843-705-1512
Mailing address:
  • Phone: 843-521-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000426
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2499
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: