Basic Information
| Provider Information | |||||||||
| NPI: | 1386873917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | LILLIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63362 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007826945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2351 ERWIN RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277054699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196944417 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2009 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18003606A | IN | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2384 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 18003606B | 01 | IN | INDIANA PROFESSIONAL LICENSING - THERAPEUTICS | OTHER | MJ3495694 | 01 | NC | DEA | OTHER | 18003606A | 01 | IN | INDIANA PROFESSIONAL LICENSING AGENCY | OTHER | 2384 | 01 | NC | NORTH CAROLINA STATE BOARD OF OPTOMETRY | OTHER |