Provider Demographics
NPI:1801014840
Name:ROSENTHAL, CHARLES A (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:718 HURRICANE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4514
Mailing Address - Country:US
Mailing Address - Phone:423-499-3737
Mailing Address - Fax:423-499-4277
Practice Address - Street 1:2040 HAMILTON PLACE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-499-3737
Practice Address - Fax:423-499-4277
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT000783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist