Provider Demographics
NPI:1457463275
Name:CHARNETSKI, CYNTHIA G (OD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:G
Last Name:CHARNETSKI
Suffix:
Gender:F
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:PO BOX 117556
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7556
Mailing Address - Country:US
Mailing Address - Phone:843-521-2020
Mailing Address - Fax:
Practice Address - Street 1:220 PEMBROKE DR STE 100
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6200
Practice Address - Country:US
Practice Address - Phone:843-785-2525
Practice Address - Fax:843-705-1512
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000426152W00000X
SC2499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001863967Medicaid
SCD24999Medicaid
817504OtherFIRST PRIORITY HEALTH
1318122OtherHIGH MARK BLUE SHIELD
83571OtherGEISINGER HEALTH PLAN
P00212048OtherRAILROAD MEDICARE
506554OtherAETNA
PA001863967Medicaid