MEDICARE: MR. CHARLES EDWARD ANDERSON III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1700X	Ocularist	UNLICENSED STATE	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316004039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES EDWARD ANDERSON III

Provider Business Mailing Address
First Line	:	4800 I-55 NORTH
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-5555
Country	:	US
Telephone Number	:	601-948-0582
Fax Number	:	601-362-1392

Provider Business Practice Location Address
First Line	:	4800 I-55 NORTH
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-5555
Country	:	US
Telephone Number	:	601-948-0582
Fax Number	:	601-362-1392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	03/01/2026

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Directions to “ MR. CHARLES EDWARD ANDERSON III ” Practice Location

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