Provider Demographics
NPI:1073516597
Name:WHISLER, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:WHISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 S ROCKFORD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-6226
Mailing Address - Country:US
Mailing Address - Phone:831-771-3900
Mailing Address - Fax:
Practice Address - Street 1:966 CASS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4539
Practice Address - Country:US
Practice Address - Phone:831-373-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A902320Medicaid
CAP00333665OtherMEDICARE RAILROAD
CA00A902320Medicaid
CA00A902320Medicare ID - Type Unspecified
CA00902320OtherBLUE SHIELD
CAP00333665OtherMEDICARE RAILROAD