Provider Demographics
NPI:1912046590
Name:FRENCH, CHARLES LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEWIS
Last Name:FRENCH
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 1:1350 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3380
Mailing Address - Country:US
Mailing Address - Phone:270-821-6241
Mailing Address - Fax:270-821-6279
Practice Address - Street 1:1350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3380
Practice Address - Country:US
Practice Address - Phone:270-821-6241
Practice Address - Fax:270-821-6279
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1285DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012854Medicaid
KY77012854Medicaid
KY1672601Medicare PIN