Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3987TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3987TG | TX |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 3987TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 3987TG | TX |
N | 152WS0006X | Sports Vision | 3987TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 3987TG | TX |
NPI | 1134118177 |
---|---|
Provider Name | Dr. Charles Shidlofsky |
First Address | Plano, TX 75024-3278 |
Second Address | Plano, TX 75024-3278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 03/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T15881 | (02) | TX |