Provider Demographics
NPI:1689667206
Name:WERNER, CHARLENE L (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:L
Last Name:WERNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 310845
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7813
Mailing Address - Country:US
Mailing Address - Phone:830-629-2570
Mailing Address - Fax:830-629-2560
Practice Address - Street 1:110 W FAUST ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7813
Practice Address - Country:US
Practice Address - Phone:830-629-2570
Practice Address - Fax:830-629-2560
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4578T152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
U22481Medicare UPIN
83206EMedicare ID - Type Unspecified