Provider Demographics
NPI:1619925724
Name:SIKES, CHARLES VAN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VAN
Last Name:SIKES
Suffix:JR
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 1:120 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505-9503
Mailing Address - Country:US
Mailing Address - Phone:919-258-9203
Mailing Address - Fax:
Practice Address - Street 1:1225 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-8984
Practice Address - Country:US
Practice Address - Phone:919-774-3556
Practice Address - Fax:919-774-7356
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410000229OtherRAILROAD MDCR LILLINGTON
NC0158090001OtherPALMETTO LILLINGTON
NC8909827Medicaid
NC7909832Medicaid
NC09832OtherBCBS OF NC
NC09832OtherBCBS LILLINGTON
NC410014665OtherRAILROAD MEDICARE SANFORD
NC410014665OtherRAILROAD MEDICARE SANFORD
NC7909832Medicaid
NC410000229OtherRAILROAD MDCR LILLINGTON
246296Medicare ID - Type UnspecifiedLILLINGTON