Provider Demographics
NPI:1629128525
Name:FERRIN, CHARLES ELLIOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ELLIOTT
Last Name:FERRIN
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 1:620 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2692
Mailing Address - Country:US
Mailing Address - Phone:928-428-0500
Mailing Address - Fax:928-428-0563
Practice Address - Street 1:620 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2692
Practice Address - Country:US
Practice Address - Phone:928-428-0500
Practice Address - Fax:928-428-0563
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70217Medicare PIN