Provider Demographics
NPI:1497766174
Name:NORTON, CHARLES W (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:NORTON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 COMMONWEALTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3321
Mailing Address - Country:US
Mailing Address - Phone:276-466-8119
Mailing Address - Fax:276-466-8188
Practice Address - Street 1:725 COMMONWEALTH AVENUE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3321
Practice Address - Country:US
Practice Address - Phone:276-466-8119
Practice Address - Fax:276-466-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000312156FX1800X
TNDP00000000120156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1254470001Medicare NSC