Provider Demographics
NPI:1316937568
Name:HADDAD, CHARLES P (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:HADDAD
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:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0489
Mailing Address - Country:US
Mailing Address - Phone:901-465-3955
Mailing Address - Fax:901-465-6797
Practice Address - Street 1:105 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1407
Practice Address - Country:US
Practice Address - Phone:901-465-3955
Practice Address - Fax:901-465-6797
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47519OtherBLUE CROSS BLUE SHIELD
13963OtherTLC MEMPHIS MANAGED CARE
2240072OtherUNITED HEALTHCARE
TN47519OtherTN CARE
TN5843OtherOMNI
410026537OtherRAIL ROAD MEDICARE
TN3591280Medicare ID - Type Unspecified
47519OtherBLUE CROSS BLUE SHIELD
TN5843OtherOMNI