Provider Demographics
NPI:1710098363
Name:TORNATORE, CHARLES W (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:TORNATORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16950 VIA TAZON
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1607
Mailing Address - Country:US
Mailing Address - Phone:858-673-2301
Mailing Address - Fax:858-521-2335
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:858-673-2301
Practice Address - Fax:858-521-2335
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0091080Medicaid
CAU29606Medicare UPIN
CASD0091080Medicaid