Provider Demographics
NPI:1932286846
Name:MCKERVEY, CHARLES J (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:MCKERVEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:186 MAIN ST.
Mailing Address - Street 2:W.G. BROWN BLDG.
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930
Mailing Address - Country:US
Mailing Address - Phone:978-283-5599
Mailing Address - Fax:978-283-7946
Practice Address - Street 1:186 MAIN ST
Practice Address - Street 2:W.G. BROWN BLDG.
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-6009
Practice Address - Country:US
Practice Address - Phone:978-283-5599
Practice Address - Fax:978-283-7946
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist