Provider Demographics
NPI:1386830487
Name:DR CHARLES R VARCOE OD PC
Entity Type:Organization
Organization Name:DR CHARLES R VARCOE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:VARCOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-993-4753
Mailing Address - Street 1:209 NILE KINNICK DR S
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1728
Mailing Address - Country:US
Mailing Address - Phone:515-993-4753
Mailing Address - Fax:515-993-4754
Practice Address - Street 1:209 NILE KINNICK DR S
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1728
Practice Address - Country:US
Practice Address - Phone:515-993-4753
Practice Address - Fax:515-993-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13948OtherMEDICARE ID-PIN
IA0139485Medicaid
IA0203480001Medicare NSC
IA0139485Medicaid