Provider Demographics
NPI:1952460651
Name:PAYNE, CHARLES KEITH (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KEITH
Last Name:PAYNE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3236
Mailing Address - Country:US
Mailing Address - Phone:540-943-3113
Mailing Address - Fax:540-943-3113
Practice Address - Street 1:1835 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3236
Practice Address - Country:US
Practice Address - Phone:540-943-3113
Practice Address - Fax:540-943-3113
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000645156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0746530001Medicare ID - Type Unspecified