Provider Demographics
NPI:1811975592
Name:VARCOE, CHARLES R (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:VARCOE
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 1:209 NILE KINNICK DR S
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1728
Mailing Address - Country:US
Mailing Address - Phone:515-993-4753
Mailing Address - Fax:515-993-4754
Practice Address - Street 1:209 NILE KINNICK DR S
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1728
Practice Address - Country:US
Practice Address - Phone:515-993-4753
Practice Address - Fax:515-993-4754
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0139485Medicaid
IA0203480001Medicare NSC
IA13948Medicare PIN