Provider Demographics
NPI:1356396592
Name:CHARLES KEITH PAYNE,INC
Entity type:Organization
Organization Name:CHARLES KEITH PAYNE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:540-943-3113
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0746530001Medicare NSC