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General NPI Number Information
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NPI Number | 1497715619
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Entity Type | Individual
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Provider Name | CHARLES THOMAS O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 420 N 2ND ST
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City | AMITE
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State | LA
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Zip | 70422-2420
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Country | US
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Telephone | 985-748-8750
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Fax | 985-748-8795
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Provider Business Mailing Address
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Address Line | 420 N 2ND ST
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City | AMITE
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State | LA
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Zip | 70422-2420
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Country | US
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Telephone | 985-748-8750
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Fax | 985-748-8795
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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 | 977254T
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License Number State | LA
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