Provider Demographics
NPI:1902818040
Name:BATES, CHARLES ROSS (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROSS
Last Name:BATES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 HOWE AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8500
Mailing Address - Country:US
Mailing Address - Phone:916-929-9162
Mailing Address - Fax:916-929-8837
Practice Address - Street 1:1111 HOWE AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8500
Practice Address - Country:US
Practice Address - Phone:916-929-9162
Practice Address - Fax:916-929-8837
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5065T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0050650Medicaid
CAT09864Medicare UPIN
CASD0050650Medicaid
CA6263200001Medicare NSC