MEDICARE: CHARLES N. THORNTON, M.D.,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G7728	TX

General Provider Information

NPI Number	:	1932156783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES N. THORNTON, M.D.,P.A.

Provider Business Mailing Address
First Line	:	1820 GALLERIA OAKS DR
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-4615
Country	:	US
Telephone Number	:	903-334-9052
Fax Number	:	903-334-9193

Provider Business Practice Location Address
First Line	:	1820 GALLERIA OAKS DR
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-4615
Country	:	US
Telephone Number	:	903-334-9052
Fax Number	:	903-334-9193

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES NEAL THORNTON
Credential	:	M.D.
Telephone Number	:	903-334-9052

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	05/08/2008

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