| Charles L. Heaton , M.d. P.a. | |
|
3415 Golden Rd Tyler TX 75701-8355 | |
| (903) 526-0444 | |
| (903) 526-2051 |
| Full Name | Charles L. Heaton , M.d. P.a. |
|---|---|
| Speciality | Ophthalmology |
| Location | 3415 Golden Rd, Tyler, Texas |
| Authorized Official Name and Position | Judith C Hodges-odom (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9035260444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles L. Heaton , M.d. P.a. 3415 Golden Rd Tyler TX 75701-8355 Ph: (903) 526-0444 | Charles L. Heaton , M.d. P.a. 3415 Golden Rd Tyler TX 75701-8355 Ph: (903) 526-0444 |
| NPI Number | 1528127172 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 06/06/2025 |
| Medicare PECOS PAC ID | 1557257615 |
|---|---|
| Medicare Enrollment ID | O20040225000598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528127172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | Todd M Nickel |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1760485627 PECOS PAC ID: 4880677442 Enrollment ID: I20040612000602 |
| Provider Name | Adam P Dossey |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1376546226 PECOS PAC ID: 6800866229 Enrollment ID: I20040730000999 |
| Provider Name | Charles L Heaton |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1326041377 PECOS PAC ID: 4981590049 Enrollment ID: I20100609000404 |
| Provider Name | Thad D Hardin |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1497758460 PECOS PAC ID: 8426192121 Enrollment ID: I20100609000435 |
| Provider Name | Joel T Muirhead |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1669475620 PECOS PAC ID: 9335283035 Enrollment ID: I20100609000445 |
| Provider Name | Matthew Marshall |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1184936353 PECOS PAC ID: 7214119411 Enrollment ID: I20111025000158 |
| Provider Name | David Schuller Risner |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1457587099 PECOS PAC ID: 8325289184 Enrollment ID: I20130722000232 |
| Provider Name | Christy Guenther |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134566391 PECOS PAC ID: 7618111527 Enrollment ID: I20141103001639 |
| Provider Name | Pamela C Carter |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1942569421 PECOS PAC ID: 6709029390 Enrollment ID: I20160622002413 |
| Provider Name | Jordan Spindle |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1740501972 PECOS PAC ID: 4880818319 Enrollment ID: I20160627002238 |
| Provider Name | William Carey Brice |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902406721 PECOS PAC ID: 4486064136 Enrollment ID: I20201109000453 |
| Provider Name | Shannon Rebecca Lebus |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1326591728 PECOS PAC ID: 9739592890 Enrollment ID: I20210108001590 |
| Provider Name | Joshua Lee Jones |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1801320544 PECOS PAC ID: 9931459914 Enrollment ID: I20220826003104 |
| Provider Name | Emily G Marsh |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1881761377 PECOS PAC ID: 6901816180 Enrollment ID: I20230718001803 |
| Provider Name | Logan Russ Vincent |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1760844906 PECOS PAC ID: 6709185713 Enrollment ID: I20240202002640 |
| Provider Name | Alden Paige Gregston |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1538620174 PECOS PAC ID: 2466899968 Enrollment ID: I20240719003431 |
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