Provider Demographics
NPI:1851054993
Name:CHARLES, AMBER RENE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 BARRON ST UNIT B100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5797
Mailing Address - Country:US
Mailing Address - Phone:504-266-1575
Mailing Address - Fax:
Practice Address - Street 1:3926 BARRON ST UNIT B100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5797
Practice Address - Country:US
Practice Address - Phone:504-266-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician