Provider Demographics
NPI:1437151719
Name:BREEN, CHARLES J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:BREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-746-1990
Mailing Address - Fax:859-746-3149
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:STE 300
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4895
Practice Address - Country:US
Practice Address - Phone:859-746-1990
Practice Address - Fax:859-746-3149
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30914174400000X, 207W00000X
OH35.067760207W00000X
OH35-06-7760-B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64309149Medicaid
OH0102347Medicaid
KY64309149Medicaid
OHBR0775135Medicare PIN
KYK087090Medicare PIN
KY0999201Medicare PIN