Provider Demographics
NPI:1811981558
Name:NORRIS, CHARLES AUSTIN (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:AUSTIN
Last Name:NORRIS
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:HCR 6100 BOX 30
Mailing Address - Street 2:
Mailing Address - City:TEECNOSPOS
Mailing Address - State:AZ
Mailing Address - Zip Code:86514
Mailing Address - Country:US
Mailing Address - Phone:928-656-5165
Mailing Address - Fax:928-656-5162
Practice Address - Street 1:US HWY 160 & NAVAJO ROUTE 25 - RED MESA
Practice Address - Street 2:
Practice Address - City:TEECNOSPOS
Practice Address - State:AZ
Practice Address - Zip Code:86514
Practice Address - Country:US
Practice Address - Phone:928-656-5165
Practice Address - Fax:928-656-5165
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2884/T823152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ303186Medicaid
NM83606262Medicaid
CO19385536Medicaid
T46964Medicare UPIN
NM83606262Medicaid
320059Medicare Oscar/Certification