Provider Demographics
NPI:1154311801
Name:CHATEAUNEUF, CHARLENE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:MARIE
Last Name:CHATEAUNEUF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2106
Mailing Address - Country:US
Mailing Address - Phone:860-233-2020
Mailing Address - Fax:860-236-4979
Practice Address - Street 1:1013 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2106
Practice Address - Country:US
Practice Address - Phone:860-233-2020
Practice Address - Fax:860-236-4979
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002622152W00000X
MA4297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT03117OtherSPECTERA
CT061354112OtherVISION SERVICE PLAN
CT061354112OtherSUPERIOR
CT061354112OtherUNITED HEALTHCARE
CT061354112OtherNEHCA
CT3393021OtherAETNA
CT090002622CT01OtherBLUE CROSS/BLUE SHIELD
CT102622OtherCONNECTICARE
CT214988OtherCOLE
CT905489OtherBLOCK
CT004239837Medicaid
CT2V5782OtherHEALTHNET
CT03117OtherSPECTERA
CT061354112OtherUNITED HEALTHCARE
CTU95703Medicare UPIN