Provider Demographics
NPI:1497720965
Name:TARNOFF, CHARLES M (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:TARNOFF
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 1:120 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2739
Mailing Address - Country:US
Mailing Address - Phone:724-465-6232
Mailing Address - Fax:724-465-0340
Practice Address - Street 1:120 S 7TH ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2739
Practice Address - Country:US
Practice Address - Phone:724-465-6232
Practice Address - Fax:724-465-0340
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005499940011Medicaid
PAT28218Medicare UPIN
PA58000082Medicare PIN
PA0005499940011Medicaid