MEDICARE: CHARLES STEVEN LANCASTER O.D.

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	OPC1541	FL

General Provider Information

NPI Number	:	1316032204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES STEVEN LANCASTER O.D.

Provider Business Mailing Address
First Line	:	204 LORA ST
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-4941
Country	:	US
Telephone Number	:	904-249-6215
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 3RD ST S
Second Line	:	SUITE 103
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6073
Country	:	US
Telephone Number	:	904-241-7865
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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