Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5622 | OH |
N | 152W00000X | Optometrist | 713 | AZ |
NPI | 1003898156 |
---|---|
Provider Name | Dr. Charles William Fornara |
First Address | Coshocton, OH 43812-1164 |
Second Address | Coshocton, OH 43812-1164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2685018 | (05) | OH |
U26490 | (02) |