Provider Demographics
NPI:1275677783
Name:NASSAUER, CHARLES A (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:NASSAUER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:170 NORTHSHORE BLVD STE C
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-6849
Practice Address - Country:US
Practice Address - Phone:985-641-1228
Practice Address - Fax:985-643-1359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA919183T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMN4126858OtherHUMANA ID
LA1380873Medicaid
LALA9183OtherEYE MED ID
LA721158167OtherTAX PAY ID
LALA99183OtherVBA ID
LA721158167OtherTAX PAY ID
LA1380873Medicaid