Provider Demographics
NPI:1629181409
Name:PAULLISKY, CHARLES J (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:PAULLISKY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1826 VETERANS BLVD
Mailing Address - Street 2:CARL VINSON VA MEDICAL CENTER - EYE CLINIC
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3620
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:478-277-2706
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:CARL VINSON VA MEDICAL CENTER - EYE CLINIC
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-277-2706
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEI30001163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist