Provider Demographics
NPI:1427407287
Name:CHARITON, NICHOLAS JORDAN (OD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JORDAN
Last Name:CHARITON
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 1:8105 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9433
Mailing Address - Country:US
Mailing Address - Phone:719-539-3581
Mailing Address - Fax:719-539-4992
Practice Address - Street 1:7162 COUNTY ROAD 154 UNIT B
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9296
Practice Address - Country:US
Practice Address - Phone:719-539-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003209152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management