Provider Demographics
NPI:1205441656
Name:CHARNEY, NATHANIEL (OD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:CHARNEY
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 1:4130 TRUXEL RD
Mailing Address - Street 2:STE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3760
Mailing Address - Country:US
Mailing Address - Phone:707-260-5300
Mailing Address - Fax:
Practice Address - Street 1:4130 TRUXEL RD STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3760
Practice Address - Country:US
Practice Address - Phone:916-928-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist