Provider Demographics
NPI:1316095094
Name:COREN, CHARLES H (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:COREN
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 1:5400 S 56TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1889
Mailing Address - Country:US
Mailing Address - Phone:402-423-0707
Mailing Address - Fax:
Practice Address - Street 1:5400 S 56TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1889
Practice Address - Country:US
Practice Address - Phone:402-423-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36334OtherBLUE CROSS BLUE SHIELD
NE100250850 00Medicaid
5100350001Medicare NSC
P00219121Medicare ID - Type UnspecifiedRAILROAD RETIREMENT
NE100250850 00Medicaid
U01275Medicare UPIN