Provider Demographics
NPI:1164630067
Name:POPIVCHAK, CHARLES W JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:POPIVCHAK
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10 W OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4209
Mailing Address - Country:US
Mailing Address - Phone:215-348-5328
Mailing Address - Fax:215-345-8516
Practice Address - Street 1:10 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4209
Practice Address - Country:US
Practice Address - Phone:215-348-5328
Practice Address - Fax:215-345-8516
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004329P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0512199OtherAETNA
PA36857OtherDAVIS
PA36857OtherDAVIS