Provider Demographics
NPI:1154706752
Name:PAPPAS, CHARLES JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:PAPPAS
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 1:42609 LAKE HOSPITALITY LN
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:FL
Mailing Address - Zip Code:32702-9547
Mailing Address - Country:US
Mailing Address - Phone:352-455-2917
Mailing Address - Fax:
Practice Address - Street 1:755 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3196
Practice Address - Country:US
Practice Address - Phone:352-455-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist