Provider Demographics
NPI:1659764579
Name:CHARLES F GARONE OD
Entity Type:Organization
Organization Name:CHARLES F GARONE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-366-2345
Mailing Address - Street 1:2030 WINTER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9347
Mailing Address - Country:US
Mailing Address - Phone:407-366-2345
Mailing Address - Fax:407-366-8245
Practice Address - Street 1:2030 WINTER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9347
Practice Address - Country:US
Practice Address - Phone:407-366-2345
Practice Address - Fax:407-366-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20740OtherMEDICARE PTAN
FL20740OtherBLUE SHIELD
FL880096371Medicare PIN
FL20740OtherBLUE SHIELD