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General NPI Number Information
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NPI Number | 1184140105
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Entity Type | Organization
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Legal Business Name | CHARLES L. HEATON , M.D. P.A.
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2394 H G MOSLEY PKWY
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City | LONGVIEW
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State | TX
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Zip | 75604-3661
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Country | US
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Telephone | 903-234-0771
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Fax | 903-234-8950
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Provider Business Mailing Address
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Address Line | 2394 H G MOSLEY PKWY
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City | LONGVIEW
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State | TX
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Zip | 75604-3661
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Country | US
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Telephone | 903-234-0771
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Fax | 903-234-8950
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Authorized Official
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Title or Position | BUSINESS 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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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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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