Provider Demographics
NPI:1942204938
Name:HOWARD, CHARLES KIRK (OD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KIRK
Last Name:HOWARD
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 1:2491 S FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-8463
Mailing Address - Country:US
Mailing Address - Phone:850-682-4014
Mailing Address - Fax:850-682-0387
Practice Address - Street 1:2491 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-8463
Practice Address - Country:US
Practice Address - Phone:850-682-4014
Practice Address - Fax:850-682-0387
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19395OtherBCBS
FL19395OtherBCBS
FL0842520001Medicare NSC
T68950Medicare UPIN