Provider Demographics
NPI:1740265933
Name:FARON, CHARLES A (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:FARON
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 1:806 CENTRAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5613
Mailing Address - Country:US
Mailing Address - Phone:847-432-6010
Mailing Address - Fax:847-432-8241
Practice Address - Street 1:806 CENTRAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-432-6010
Practice Address - Fax:847-432-8241
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008232152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618233OtherBCBS
IL046008232Medicaid
IL01618235OtherBCBS
IL04915295OtherBCBS
IL410039326OtherRR MEDICARE
IL410039327OtherRR MEDICARE
U19300Medicare UPIN
ILL81325Medicare PIN
IL01618235OtherBCBS