Provider Demographics
NPI:1508940198
Name:CHARENDOFF, SAM J (OD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:J
Last Name:CHARENDOFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2500 DANIEL MCCALL DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-639-6044
Mailing Address - Fax:936-639-6398
Practice Address - Street 1:2500 DANIEL MCCALL DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-639-6044
Practice Address - Fax:936-639-6398
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070FEOtherBLUE CROSS
TX18481OtherSPECTERA
TXG0000E14Q8Medicaid
TXOOE14QMedicare ID - Type Unspecified