Provider Demographics
NPI:1396930947
Name:TRIBBEY, CHARLES LEE (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEE
Last Name:TRIBBEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7605 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4433
Mailing Address - Country:US
Mailing Address - Phone:805-541-2333
Mailing Address - Fax:805-543-5795
Practice Address - Street 1:719 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3512
Practice Address - Country:US
Practice Address - Phone:805-541-2333
Practice Address - Fax:805-543-5795
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6822 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist