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General NPI Number Information
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NPI Number | 1649575291
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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 | 01/12/2011
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 1205 N 6TH ST
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City | LONGVIEW
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State | TX
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Zip | 75601-5539
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Country | US
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Telephone | 903-234-0771
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Fax | 903-234-0775
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Provider Business Mailing Address
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Address Line | 3415 GOLDEN RD
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City | TYLER
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State | TX
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Zip | 75701-8355
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Country | US
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Telephone | 903-526-0444
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Fax | 903-526-2051
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JUDITH HODGES-ODOM
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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