Provider Demographics
NPI:1437161619
Name:CHATMAN, CHARLES SUMMER (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SUMMER
Last Name:CHATMAN
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 1:11155 77TH AVE
Mailing Address - Street 2:#1C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7035
Mailing Address - Country:US
Mailing Address - Phone:718-793-3096
Mailing Address - Fax:
Practice Address - Street 1:648 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3801
Practice Address - Country:US
Practice Address - Phone:212-927-4444
Practice Address - Fax:212-568-8669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT12619Medicare UPIN
NYC4384C0732Medicare ID - Type Unspecified