Provider Demographics
NPI:1891856043
Name:BELL, CHARLES JEROME (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JEROME
Last Name:BELL
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 1:302 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-1714
Mailing Address - Country:US
Mailing Address - Phone:334-727-6247
Mailing Address - Fax:334-725-1600
Practice Address - Street 1:302 N ELM ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1714
Practice Address - Country:US
Practice Address - Phone:334-727-6247
Practice Address - Fax:334-725-1600
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS546 - TA 112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0447500001OtherCIGNA GOVERMENT SERVICES