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General NPI Number Information
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NPI Number | 1144115742
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Entity Type | Organization
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Legal Business Name | CHARLES L. HEATON, MD, PA
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2415 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-3639
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Country | US
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Telephone | 903-526-0444
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Fax | 903-595-6650
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Provider Business Mailing Address
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Address Line | 3355 EARL CAMPBELL PKWY
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City | TYLER
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State | TX
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Zip | 75701-8435
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Country | US
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Telephone | 903-526-0444
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | TERRAN L SMITH
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Credential |
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Telephone | 903-526-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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