Provider Demographics
NPI:1407951320
Name:BURTON, CHARLES DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:BURTON
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 8227
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-8227
Mailing Address - Country:US
Mailing Address - Phone:256-546-8074
Mailing Address - Fax:256-546-0376
Practice Address - Street 1:245 S 6TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4102
Practice Address - Country:US
Practice Address - Phone:256-546-8074
Practice Address - Fax:256-546-0376
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-489-TA-125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059687Medicaid
AL51059687OtherALABAMA BLUE CROSS & BLUE
AL180007138OtherRAILROAD MEDICARE
AL51059687OtherALABAMA BLUE CROSS & BLUE
AL180007138OtherRAILROAD MEDICARE
ALT69144Medicare UPIN