Provider Demographics
NPI:1013086164
Name:HORNBERGER, CHARLES JOSEPH SR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:HORNBERGER
Suffix:SR
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 1:8425 BOSTON STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:NY
Mailing Address - Zip Code:14025
Mailing Address - Country:US
Mailing Address - Phone:716-941-6129
Mailing Address - Fax:716-941-9281
Practice Address - Street 1:8425 BOSTON STATE ROAD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:NY
Practice Address - Zip Code:14025
Practice Address - Country:US
Practice Address - Phone:716-941-5585
Practice Address - Fax:716-941-9281
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1185Medicare ID - Type UnspecifiedGROUP NUMBER
T88321Medicare UPIN
NYCC8264Medicare ID - Type Unspecified