Provider Demographics
NPI:1740268531
Name:RICE, CHARLES AVERY (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:AVERY
Last Name:RICE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5200
Mailing Address - Street 2:207 WEST STATELINE
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257
Mailing Address - Country:US
Mailing Address - Phone:731-479-1334
Mailing Address - Fax:431-479-1334
Practice Address - Street 1:207 WEST STATE LINE
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257
Practice Address - Country:US
Practice Address - Phone:731-479-1334
Practice Address - Fax:731-479-1334
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0662152W00000X
KY0831DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008316OtherKY MEDICAID
TN0073836OtherBCBS TN
410047175OtherRAILROAD MEDICARE
TN0073836OtherBCBS TN
410047175OtherRAILROAD MEDICARE