Provider Demographics
NPI:1841342953
Name:DAHLMAN, CHARLES JAY (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAY
Last Name:DAHLMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 CRESTA DR APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-5555
Mailing Address - Country:US
Mailing Address - Phone:415-479-8192
Mailing Address - Fax:
Practice Address - Street 1:1033 3RD ST
Practice Address - Street 2:EYE DEPARTMENT
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3107
Practice Address - Country:US
Practice Address - Phone:415-482-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8447T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist