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General NPI Number Information
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NPI Number | 1487878997
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Entity Type | Individual
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Provider Name | CHARLES IVAN RALEIGH O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 20111 ROUTE 19 109
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6207
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Country | US
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Telephone | 724-741-0900
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Fax | 724-741-0915
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Provider Business Mailing Address
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Address Line | 210 WOODBINE LN
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City | MARS
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State | PA
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Zip | 16046-7126
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Country | US
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Telephone | 724-779-9717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002167
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License Number State | PA
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