Provider Demographics
NPI:1346766698
Name:BAILEY, CHARLES STANLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STANLEY
Last Name:BAILEY
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 1:3098 E WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7621
Mailing Address - Country:US
Mailing Address - Phone:480-219-6207
Mailing Address - Fax:
Practice Address - Street 1:3098 E. WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-219-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1572152W00000X
AZ1362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist