Provider Demographics
NPI:1851383186
Name:HARRILL, CHARLES WINSTON (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WINSTON
Last Name:HARRILL
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:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-0667
Mailing Address - Country:US
Mailing Address - Phone:804-746-1950
Mailing Address - Fax:804-746-3275
Practice Address - Street 1:7290 HANOVER GREEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1706
Practice Address - Country:US
Practice Address - Phone:804-746-1950
Practice Address - Fax:804-746-3275
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00923583Medicaid
VA580936386Medicare PIN
T21490Medicare UPIN