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General NPI Number Information
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NPI Number | 1609858786
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Entity Type | Individual
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Provider Name | CHARLES J KORTH OD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 1 W CALIFORNIA BLVD SUITE 513
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City | PASADENA
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State | CA
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Zip | 91105-3029
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Country | US
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Telephone | 626-793-9987
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W CALIFORNIA BLVD SUITE 513
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City | PASADENA
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State | CA
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Zip | 91105-3043
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Country | US
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Telephone | 626-793-9987
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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 | OPT 9449 TPA
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License Number State | CA
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