Healthcare Provider Details

I. General information

NPI: 1093638728
Provider Name (Legal Business Name): CHARLSEY FELDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 GARDEN PARK DR
MADISON MS
39110-5505
US

IV. Provider business mailing address

207 LAKE CREST DR
MADISON MS
39110-1226
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-2259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1133
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: