MEDICARE: DR. CHARLES JOSEPH HORNBERGER SR. OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2750	NY

General Provider Information

NPI Number	:	1013086164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JOSEPH HORNBERGER SR. OD

Provider Business Mailing Address
First Line	:	8425 BOSTON STATE ROAD
Second Line	:
City	:	BOSTON
State	:	NY
Zip	:	14025
Country	:	US
Telephone Number	:	716-941-6129
Fax Number	:	716-941-9281

Provider Business Practice Location Address
First Line	:	8425 BOSTON STATE ROAD
Second Line	:
City	:	BOSTON
State	:	NY
Zip	:	14025
Country	:	US
Telephone Number	:	716-941-5585
Fax Number	:	716-941-9281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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