Provider Demographics
NPI:1144215575
Name:CHARM, HARRY JOEL (OD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:JOEL
Last Name:CHARM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6200 E CANYON RIM RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4317
Mailing Address - Country:US
Mailing Address - Phone:714-998-2020
Mailing Address - Fax:714-998-2034
Practice Address - Street 1:6200 E CANYON RIM RD
Practice Address - Street 2:STE 101
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807-4317
Practice Address - Country:US
Practice Address - Phone:714-998-2020
Practice Address - Fax:714-998-2034
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5511TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGV624ZMedicare PIN
CAGV617AMedicare UPIN