Charles A Banks, OD
Individual provider Active NPI Optometrist · Raytown, MO
NPI 1124002134 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1124002134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- T02112 (MO)
- Practice address
- 6708 Raytown Rd
Raytown, MO 64133-5272 - Phone
- (816) 353-1872
- Fax
- (816) 353-5022
- NPI assigned
- Dec 2, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T02112 | MO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02112 | MO | Yes |
Addresses
Primary practice location
6708 Raytown Rd
Raytown, MO 64133-5272
Mailing address
6708 Raytown Rd
Raytown, MO 64133-5272
Phone (816) 353-1872
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T02112 | Other | MO | LICENSE |
Other providers in Raytown, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.