Provider Demographics
NPI:1619144011
Name:MATTOX, CHARLOTTE A (DO)
Entity Type:Individual
Prefix:MR
First Name:CHARLOTTE
Middle Name:A
Last Name:MATTOX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 W HAPPY CANYON RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3909
Mailing Address - Country:US
Mailing Address - Phone:303-663-2034
Mailing Address - Fax:303-663-3428
Practice Address - Street 1:856 W HAPPY CANYON RD
Practice Address - Street 2:STE 110
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3909
Practice Address - Country:US
Practice Address - Phone:303-663-2034
Practice Address - Fax:303-663-3428
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3983156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician