Provider Demographics
NPI:1861679011
Name:CHARLES W. HARRILL, O. D.
Entity Type:Organization
Organization Name:CHARLES W. HARRILL, O. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRILL
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:804-746-1950
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000061332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0283330001Medicare NSC