Provider Demographics
NPI:1639219223
Name:BAILEY, CHARLES STANLEY III (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STANLEY
Last Name:BAILEY
Suffix:III
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 1:3931 NE GARDENIA LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9287
Mailing Address - Country:US
Mailing Address - Phone:515-554-8283
Mailing Address - Fax:
Practice Address - Street 1:6351 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1709
Practice Address - Country:US
Practice Address - Phone:515-953-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist