Provider Demographics
NPI:1669489902
Name:MCARTHUR, CHARLES SCOT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SCOT
Last Name:MCARTHUR
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 1:117 DEER RUN STRUT
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7813
Mailing Address - Country:US
Mailing Address - Phone:334-347-4777
Mailing Address - Fax:334-673-2394
Practice Address - Street 1:900 COMMONS DR
Practice Address - Street 2:SUITE 605
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2283
Practice Address - Country:US
Practice Address - Phone:334-794-4644
Practice Address - Fax:334-673-2394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-381TA276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058489Medicaid
AL58489Medicare ID - Type Unspecified
T68978Medicare UPIN