Provider Demographics
NPI:1053493361
Name:REGISTER, CHARLES D (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:REGISTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7017
Mailing Address - Country:US
Mailing Address - Phone:386-423-7788
Mailing Address - Fax:386-423-0035
Practice Address - Street 1:103 FAULKNER ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7017
Practice Address - Country:US
Practice Address - Phone:386-423-7788
Practice Address - Fax:386-423-0035
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93879Medicare UPIN
FL5119790001Medicare NSC
FL19973Medicare PIN
FL078276900Medicaid