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General NPI Number Information
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NPI Number | 1346766698
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Entity Type | Individual
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Provider Name | CHARLES STANLEY BAILEY OD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3098 E. WATERMAN WAY
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 480-219-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 3098 E WATERMAN WAY
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City | GILBERT
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State | AZ
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Zip | 85297-7621
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Country | US
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Telephone | 480-219-6207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1572
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1362
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License Number State | AZ
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