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General NPI Number Information
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NPI Number | 1841342953
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Entity Type | Individual
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Provider Name | CHARLES JAY DAHLMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1033 3RD ST EYE DEPARTMENT
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3107
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Country | US
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Telephone | 415-482-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 50 CRESTA DR APT 9
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City | SAN RAFAEL
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State | CA
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Zip | 94903-5555
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Country | US
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Telephone | 415-479-8192
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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 | 8447T
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License Number State | CA
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