Provider Demographics
NPI:1972837854
Name:EUBANKS, CHARLES R (FLO)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:FLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 COREY AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1901
Mailing Address - Country:US
Mailing Address - Phone:727-360-2511
Mailing Address - Fax:
Practice Address - Street 1:415 COREY AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-1901
Practice Address - Country:US
Practice Address - Phone:727-360-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1944156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician