Provider Demographics
NPI:1861482093
Name:COLLINS, CHARLES GARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GARRY
Last Name:COLLINS
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 1:409 ROYAL XING
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8909
Mailing Address - Country:US
Mailing Address - Phone:615-731-8900
Mailing Address - Fax:615-731-8990
Practice Address - Street 1:115 PENN WARREN DR
Practice Address - Street 2:SUITE 450
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5047
Practice Address - Country:US
Practice Address - Phone:615-447-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3343678OtherAETNA
TN4082418OtherBCBS
TN3412976OtherAETNA
TN3468268OtherAETNA
TN3597679Medicaid
TN4061254OtherBCBS
TN4061289OtherBCBS
TN4092009OtherBCBS
TN3343675OtherAETNA
TN4061401OtherBCBS
TN4061332OtherBCBS
TNTN1301OtherEYEMED
TN910689OtherBLOCK
TN4061289OtherBCBS
TN3946204Medicare ID - Type Unspecified
TN3343675OtherAETNA
TN910689OtherBLOCK
TN3946205Medicare ID - Type Unspecified
TN3597675Medicare ID - Type Unspecified
TN4061254OtherBCBS