Provider Demographics
NPI:1174049191
Name:CHARLES L. HEATON , M.D. P.A.
Entity type:Organization
Organization Name:CHARLES L. HEATON , M.D. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:IT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-526-0444
Mailing Address - Street 1:1600 US HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-4508
Mailing Address - Country:US
Mailing Address - Phone:903-657-9571
Mailing Address - Fax:903-655-1777
Practice Address - Street 1:1600 US HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4508
Practice Address - Country:US
Practice Address - Phone:903-657-9571
Practice Address - Fax:903-655-1777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES L. HEATON , M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier