Provider Demographics
NPI:1346516747
Name:CHARLES D REGISTER OD, PA
Entity Type:Organization
Organization Name:CHARLES D REGISTER OD, PA
Other - Org Name:BEACH VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-423-7788
Mailing Address - Street 1:1928 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8345
Mailing Address - Country:US
Mailing Address - Phone:396-423-7788
Mailing Address - Fax:386-423-0035
Practice Address - Street 1:1928 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8345
Practice Address - Country:US
Practice Address - Phone:396-423-7788
Practice Address - Fax:386-423-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078276900Medicaid
T93879Medicare UPIN
19973Medicare PIN