Provider Demographics
NPI:1083694129
Name:WAITKUS, CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:WAITKUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SUMMERS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1239
Mailing Address - Country:US
Mailing Address - Phone:304-343-3937
Mailing Address - Fax:304-344-3957
Practice Address - Street 1:43 EAGLES RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3643
Practice Address - Country:US
Practice Address - Phone:304-253-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV934-IOD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist