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General NPI Number Information
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NPI Number | 1811981558
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Entity Type | Individual
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Provider Name | CHARLES AUSTIN NORRIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | US HWY 160 & NAVAJO ROUTE 25 - RED MESA
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City | TEECNOSPOS
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State | AZ
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Zip | 86514
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Country | US
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Telephone | 928-656-5165
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Fax | 928-656-5165
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Provider Business Mailing Address
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Address Line | HCR 6100 BOX 30
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City | TEECNOSPOS
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State | AZ
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Zip | 86514
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Country | US
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Telephone | 928-656-5165
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Fax | 928-656-5162
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2884/T823
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License Number State | OH
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