Provider Demographics
NPI:1235238759
Name:DR. CHARLES V. DILEO & ASSOCIATES
Entity Type:Organization
Organization Name:DR. CHARLES V. DILEO & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-465-0085
Mailing Address - Street 1:1401 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2845
Mailing Address - Country:US
Mailing Address - Phone:504-465-0085
Mailing Address - Fax:504-465-0447
Practice Address - Street 1:1401 W ESPLANADE AVE
Practice Address - Street 2:SUITE 2020
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2845
Practice Address - Country:US
Practice Address - Phone:504-465-0085
Practice Address - Fax:504-465-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA934-223T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900H1183ZOtherBLUECROSS BLUESHIELD OF LOUISIANA
LA57069Medicare PIN
LA1900H1183ZOtherBLUECROSS BLUESHIELD OF LOUISIANA