Provider Demographics
NPI:1609953827
Name:POPE, CHARLES WILSON (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILSON
Last Name:POPE
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 1:130 EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3711
Mailing Address - Country:US
Mailing Address - Phone:870-836-6886
Mailing Address - Fax:870-836-2345
Practice Address - Street 1:130 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3711
Practice Address - Country:US
Practice Address - Phone:870-836-6886
Practice Address - Fax:870-836-2345
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07248Medicare UPIN
49938Medicare ID - Type Unspecified