Provider Demographics
NPI:1225275100
Name:TO, CHARLENE Y (OD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:Y
Last Name:TO
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 1:1724 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3858
Mailing Address - Country:US
Mailing Address - Phone:716-684-3996
Mailing Address - Fax:
Practice Address - Street 1:2000 WALDEN AVE
Practice Address - Street 2:WALDEN GALLERIA
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5454
Practice Address - Country:US
Practice Address - Phone:716-684-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7343-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist