Provider Demographics
NPI:1740377761
Name:CHARLTON, ANGELA SUE (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SUE
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:403 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:918-689-2677
Mailing Address - Fax:918-689-2901
Practice Address - Street 1:742 N. YORK
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403
Practice Address - Country:US
Practice Address - Phone:918-682-7752
Practice Address - Fax:918-687-8440
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist