Provider Demographics
NPI:1700316593
Name:PHILPY, CHARLES NOLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NOLAN
Last Name:PHILPY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3825
Mailing Address - Country:US
Mailing Address - Phone:719-336-3311
Mailing Address - Fax:719-336-3172
Practice Address - Street 1:1607 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-3311
Practice Address - Fax:719-336-3172
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist