Provider Demographics
NPI:1255517074
Name:CHARLES E MOORHEAD OD PS INC
Entity type:Organization
Organization Name:CHARLES E MOORHEAD OD PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-692-0923
Mailing Address - Street 1:4898 NW FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9239
Mailing Address - Country:US
Mailing Address - Phone:360-308-0052
Mailing Address - Fax:
Practice Address - Street 1:6797 STATE HIGHWAY 303 NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3736
Practice Address - Country:US
Practice Address - Phone:360-692-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center