Healthcare Provider Details

I. General information

NPI: 1548535149
Provider Name (Legal Business Name): CHARLES N. HOWELL, JR. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 UNIVERSITY BLVD S STE 1
JACKSONVILLE FL
32216-8936
US

IV. Provider business mailing address

2115 UNIVERSITY BLVD S STE 1
JACKSONVILLE FL
32216-8936
US

V. Phone/Fax

Practice location:
  • Phone: 904-725-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES N. HOWELL JR.
Title or Position: OWNER
Credential: O.D., M.ED, P.A.
Phone: 904-725-2300