Basic Information
| Provider Information | |||||||||
| NPI: | 1245265313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILCHRIST | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1290 | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245511290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343855600 | ||||||||
| FaxNumber: | 4344557172 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | TAPPAHANNOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044435388 | ||||||||
| FaxNumber: | 8044435389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618000691 | VA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 061320 | 01 | VA | ANTHEM | OTHER | 009204491 | 05 | VA | MEDICAID |