Provider Demographics
NPI:1932768686
Name:LOVE, CHARLOTTE FERN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:FERN
Last Name:LOVE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:FERN
Other - Last Name:MASSOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65-1227B OPELO RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8443
Mailing Address - Country:US
Mailing Address - Phone:808-885-4000
Mailing Address - Fax:
Practice Address - Street 1:65-1227B OPELO RD STE 5
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8443
Practice Address - Country:US
Practice Address - Phone:808-885-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist