Provider Demographics
NPI:1356376180
Name:CHARET, ROBERT LANCE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANCE
Last Name:CHARET
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12954 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4418
Mailing Address - Country:US
Mailing Address - Phone:310-676-1373
Mailing Address - Fax:
Practice Address - Street 1:12954 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4418
Practice Address - Country:US
Practice Address - Phone:310-676-1373
Practice Address - Fax:310-676-1914
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-10-14
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Provider Licenses
StateLicense IDTaxonomies
CAG72293207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G722930Medicaid
CAF18422Medicare UPIN