Provider Demographics
NPI:1720753973
Name:COHEN, CHARLES A (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:COHEN
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 1:2148 OCEAN AVE STE 603
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1485
Mailing Address - Country:US
Mailing Address - Phone:718-339-5100
Mailing Address - Fax:
Practice Address - Street 1:2148 OCEAN AVE STE 603
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1485
Practice Address - Country:US
Practice Address - Phone:718-339-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist