Provider Demographics
NPI:1295824043
Name:POPE, CHARLES G (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:POPE
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:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0996
Mailing Address - Country:US
Mailing Address - Phone:870-836-6886
Mailing Address - Fax:870-836-2345
Practice Address - Street 1:130 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3711
Practice Address - Country:US
Practice Address - Phone:870-836-6886
Practice Address - Fax:870-836-2345
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16335000040OtherQUAL CHOICE
AR48407OtherARBCBS
T20194Medicare UPIN
AR0314790001Medicare NSC
AR48407OtherARBCBS