Provider Demographics
NPI:1477572238
Name:BICE, CHARLES R JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BICE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-7372
Mailing Address - Fax:423-578-4369
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-246-7372
Practice Address - Fax:423-578-4369
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN0000008499207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3163556Medicaid
TN3163556Medicaid
3163556Medicare ID - Type Unspecified