Provider Demographics
NPI:1104154889
Name:CHARLES FRENCH OPTOMETRIST PSC
Entity type:Organization
Organization Name:CHARLES FRENCH OPTOMETRIST PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-821-6241
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1285DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1184580001Medicare NSC