Provider Demographics
NPI:1992831093
Name:HOWELL, CHARLES NOLAN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NOLAN
Last Name:HOWELL
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2115 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8936
Mailing Address - Country:US
Mailing Address - Phone:904-725-2300
Mailing Address - Fax:904-725-6811
Practice Address - Street 1:2115 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8936
Practice Address - Country:US
Practice Address - Phone:904-725-2300
Practice Address - Fax:904-725-6811
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54773Medicare UPIN
FL20082Medicare ID - Type Unspecified