MEDICARE: CHARLES D REGISTER 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	OPC1689	FL

General Provider Information

NPI Number	:	1053493361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES D REGISTER OD

Provider Business Mailing Address
First Line	:	103 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7017
Country	:	US
Telephone Number	:	386-423-7788
Fax Number	:	386-423-0035

Provider Business Practice Location Address
First Line	:	103 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7017
Country	:	US
Telephone Number	:	386-423-7788
Fax Number	:	386-423-0035

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	05/24/2016

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