Provider Demographics
NPI:1801154760
Name:NUNEZ, CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:NUNEZ
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 1:25 W COLLEGE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4701
Mailing Address - Country:US
Mailing Address - Phone:813-886-2020
Mailing Address - Fax:888-805-7385
Practice Address - Street 1:1771 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4757
Practice Address - Country:US
Practice Address - Phone:386-304-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist