Provider Demographics
NPI:1689820805
Name:CHARRON, PETER (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:CHARRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1616 CORNWALL AVE
Mailing Address - Street 2:105
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4648
Mailing Address - Country:US
Mailing Address - Phone:360-393-4479
Mailing Address - Fax:360-746-8661
Practice Address - Street 1:1616 CORNWALL AVE
Practice Address - Street 2:105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4648
Practice Address - Country:US
Practice Address - Phone:360-393-4479
Practice Address - Fax:360-746-8661
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60173370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist