Provider Demographics
NPI:1184681306
Name:CHARLES, JAMES LARRY JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LARRY
Last Name:CHARLES
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:523 S SANTA FE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6291
Mailing Address - Country:US
Mailing Address - Phone:405-330-1100
Mailing Address - Fax:405-330-1192
Practice Address - Street 1:523 S SANTA FE AVE
Practice Address - Street 2:STE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6291
Practice Address - Country:US
Practice Address - Phone:405-330-1100
Practice Address - Fax:405-330-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKOK2094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK100381Medicare PIN