Provider Demographics
NPI:1124357868
Name:CHARLES, RALPH BRADELEY (LDO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:BRADELEY
Last Name:CHARLES
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14612 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-3030
Mailing Address - Country:US
Mailing Address - Phone:305-390-2326
Mailing Address - Fax:786-522-0681
Practice Address - Street 1:14612 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-3030
Practice Address - Country:US
Practice Address - Phone:305-390-2326
Practice Address - Fax:786-522-0681
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician