Provider Demographics
NPI:1366440588
Name:PARSONS, CHARLIE JOHN (O D)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:JOHN
Last Name:PARSONS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EASTERN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1100
Mailing Address - Country:US
Mailing Address - Phone:717-597-7708
Mailing Address - Fax:717-597-1052
Practice Address - Street 1:50 EASTERN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1100
Practice Address - Country:US
Practice Address - Phone:717-597-7708
Practice Address - Fax:717-597-1052
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA188640OtherHEALTH AMERICA HEALTH ASSURANCE
PA39776OtherHIGHMARK BLUE SHIELD
PA833045OtherAETNA HMO
PA410000963OtherRAILROAD MEDICARE
PA5187071OtherAETNA PPO
PA01436201OtherCBC
PA39776OtherHIGHMARK BLUE SHIELD
PA0197150001Medicare NSC