Provider Demographics
NPI:1629326335
Name:CAMERON, CHARLES J (BC HIS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:CAMERON
Suffix:
Gender:M
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 SE 16TH PL STE 104
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7474
Mailing Address - Country:US
Mailing Address - Phone:239-471-7148
Mailing Address - Fax:
Practice Address - Street 1:4406 SE 16TH PL STE 104
Practice Address - Street 2:UNIT 2
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7474
Practice Address - Country:US
Practice Address - Phone:239-471-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4816237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist