Provider Demographics
NPI:1891894663
Name:YU, CHARLES SHIH (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SHIH
Last Name:YU
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 1:1038 ALYSSUM DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-8124
Mailing Address - Country:US
Mailing Address - Phone:678-575-5068
Mailing Address - Fax:
Practice Address - Street 1:1038 ALYSSUM DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-8124
Practice Address - Country:US
Practice Address - Phone:678-575-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist