Basic Information
| Provider Information | |||||||||
| NPI: | 1174677066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4810 TECUMSEH AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124750035 | ||||||||
| FaxNumber: | 8124774537 | ||||||||
| Practice Location | |||||||||
| Address1: | 6614 LOGAN DR | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776700 | ||||||||
| FaxNumber: | 8124772152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18001803A | IN | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 4807T1649 | OH | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0880DT | KY | N | Eye and Vision Services Providers | Optometrist |
No ID Information.