Provider Demographics
NPI:1841411154
Name:PEREZ-BLANCO, CHARLES E (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:PEREZ-BLANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-858-4500
Mailing Address - Fax:305-858-8999
Practice Address - Street 1:2345 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-858-4500
Practice Address - Fax:305-858-8999
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4775156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician