Individual
DR. CHARLES W PAEPKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV003778-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000406946002
BLUE SHIELD NE NY
NY
01
—
P010003778
EXCELLUS
NY
Enumeration date
05/05/2006
Last updated
02/08/2013
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