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General NPI Number Information
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NPI Number | 1962767665
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Entity Type | Individual
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Provider Name | CHARLES WILLIAM PELTON O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 126 S MAIN ST
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City | DE SOTO
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State | MO
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Zip | 63020-2104
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Country | US
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Telephone | 636-586-5406
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Fax | 636-586-1969
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Provider Business Mailing Address
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Address Line | 126 S MAIN ST
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City | DE SOTO
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State | MO
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Zip | 63020-2104
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Country | US
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Telephone | 636-586-5406
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Fax | 636-586-1969
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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 | 2012017231
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License Number State | MO
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