Provider Demographics
NPI:1497818876
Name:POLGLASE, CHARLES K (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:POLGLASE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:506 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1802
Mailing Address - Country:US
Mailing Address - Phone:508-984-4062
Mailing Address - Fax:774-628-9681
Practice Address - Street 1:506 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1802
Practice Address - Country:US
Practice Address - Phone:508-984-4062
Practice Address - Fax:774-628-9681
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist