Provider Demographics
NPI:1942288659
Name:OSTROV, CHARLES S (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:OSTROV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8401 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4486
Mailing Address - Country:US
Mailing Address - Phone:763-383-4130
Mailing Address - Fax:763-383-4147
Practice Address - Street 1:5657 DULUTH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4054
Practice Address - Country:US
Practice Address - Phone:763-416-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN16290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95797Medicare UPIN