Individual provider Active NPI

Charles R Descheneaux, OD

  • Optometrist
  • Orlando, FL
National Provider Identifier
1154319366
Registry record updated Jun 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC3108 Issued in FL
Practice address
12715 Pegasus Dr
Orlando, FL 32816-8030
Phone
(407) 365-4040
NPI assigned
Oct 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC3108 FL Primary

Addresses

Primary practice location

12715 Pegasus Dr
Orlando, FL 32816-8030

Mailing address

2984 Alafaya TRL
#1030
Oviedo, FL 32765-7628
Phone (407) 365-4040

Other identifiers 2

IdentifierTypeStateIssuer
620387601MedicaidFL
620387600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080506000655 FL Practitioner - Optometry 4284654112 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Source Maitland, LLC Optometrist CurrentSince Aug 1, 2016 Accepting new patients
Sightrite Medical FL PLLC Optometrist CurrentSince Oct 1, 2020 Accepting new patients
Bruce W Anderson, P.a. Optometrist PastSince Jan 1, 1999 Accepting new patients

Locations

575 Lamar Ave
Brooksville, FL 34601
Phone (352) 799-2226

17781 Thelma Ave
Jupiter, FL 33458
Phone (561) 746-2998

1800 NE 168th St
North Miami Beach, FL 33162
Phone (305) 917-1800

1020 Lockwood Blvd
Oviedo, FL 32765
Phone (407) 971-1001

267 Broadway
Brooklyn, NY 11211

267 Broadway
Fl 2
Brooklyn, NY 11211
Phone (716) 912-5877

Networks

  • Freedom Health HMO Network

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781827200000",
    "number": "1154319366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2984 ALAFAYA TRL",
            "address_2": "#1030",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327657628",
            "telephone_number": "407-365-4040",
            "fax_number": "407-365-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12715 PEGASUS DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328168030",
            "telephone_number": "407-365-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESCHENEAUX",
        "first_name": "CHARLES",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2026-06-19",
        "certification_date": "2026-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620387601",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620387600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.