Provider Demographics
NPI:1194728899
Name:ALLEN, CHARLES D (OD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:ALLEN
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 1:601 EWING ST
Mailing Address - Street 2:STE A-15
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2761
Mailing Address - Country:US
Mailing Address - Phone:609-924-3567
Mailing Address - Fax:609-924-2852
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:STE A-15
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-924-3567
Practice Address - Fax:609-924-2852
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00268000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU25260Medicare UPIN
NJ521241Medicare ID - Type Unspecified