Provider Demographics
NPI:1154389476
Name:CHARTERS, DOUGLAS OWEN (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:OWEN
Last Name:CHARTERS
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 1:5770 N FIRST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-432-1700
Mailing Address - Fax:559-435-9521
Practice Address - Street 1:5770 N FIRST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-432-1700
Practice Address - Fax:559-435-9521
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4642T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154389476Medicaid
CA0353390001Medicare NSC
T09727Medicare UPIN
CASD046420Medicare ID - Type Unspecified