Provider Demographics
NPI:1255332441
Name:ATWELL, CHARLES K (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:ATWELL
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 1:2010 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-9482
Mailing Address - Country:US
Mailing Address - Phone:630-406-0606
Mailing Address - Fax:630-406-0996
Practice Address - Street 1:2010 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-9482
Practice Address - Country:US
Practice Address - Phone:630-406-0606
Practice Address - Fax:630-406-0996
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist