Provider Demographics
NPI:1760504575
Name:WEST, CHARLES W
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 CARROLLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3637
Mailing Address - Country:US
Mailing Address - Phone:276-238-1000
Mailing Address - Fax:276-238-9977
Practice Address - Street 1:2851 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3637
Practice Address - Country:US
Practice Address - Phone:276-238-1000
Practice Address - Fax:276-238-9977
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1172156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician