Healthcare Provider Details

I. General information

NPI: 1184140105
Provider Name (Legal Business Name): CHARLES L. HEATON , M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2394 H G MOSLEY PKWY
LONGVIEW TX
75604-3661
US

IV. Provider business mailing address

2394 H G MOSLEY PKWY
LONGVIEW TX
75604-3661
US

V. Phone/Fax

Practice location:
  • Phone: 903-234-0771
  • Fax: 903-234-8950
Mailing address:
  • Phone: 903-234-0771
  • Fax: 903-234-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: TERRAN L SMITH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 903-526-0444