Provider Demographics
NPI:1689737843
Name:METZLER, CHARLES FREDRICK JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDRICK
Last Name:METZLER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:25737 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3221
Mailing Address - Country:US
Mailing Address - Phone:315-629-4316
Mailing Address - Fax:315-629-4319
Practice Address - Street 1:25737 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3221
Practice Address - Country:US
Practice Address - Phone:315-629-4316
Practice Address - Fax:315-629-4319
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00437352Medicaid
NY00437352Medicaid