Basic Information
| Provider Information | |||||||||
| NPI: | 1568859247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES A SHALLER MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 WESTGATE PLZ | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287341422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283694236 | ||||||||
| FaxNumber: | 8283690753 | ||||||||
| Practice Location | |||||||||
| Address1: | 36 WESTGATE PLZ | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287341422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283694236 | ||||||||
| FaxNumber: | 8283690753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | SHALLER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8284210112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 9400350 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.