Provider Demographics
NPI:1316032204
Name:LANCASTER, CHARLES STEVEN (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEVEN
Last Name:LANCASTER
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 1:204 LORA ST
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4941
Mailing Address - Country:US
Mailing Address - Phone:904-249-6215
Mailing Address - Fax:
Practice Address - Street 1:3316 3RD ST S
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6073
Practice Address - Country:US
Practice Address - Phone:904-241-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61834Medicare UPIN
FL19304XMedicare ID - Type Unspecified