NPIMap

Organization Active NPI

Charles L. Heaton , M.D. P.a.

Doing business as Heaton Eye Assoicates Optical Shop

  • Eyewear Supplier
  • Tyler, TX
National Provider Identifier
1124545413
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
CHARLES L. HEATON , M.D. P.A.
Doing business as
Heaton Eye Assoicates Optical Shop
Practice address
3355 Earl Campbell Pkwy
Tyler, TX 75701-8435
Phone
(903) 526-0444
NPI assigned
Aug 28, 2017
Last updated
Oct 8, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CHARLES L. HEATON , M.D. P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judith C Hodges-Odom
Title
Credentialing
Phone
(903) 526-0444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

3355 Earl Campbell Pkwy
Tyler, TX 75701-8435

Mailing address

3355 Earl Campbell Pkwy
Tyler, TX 75701-8435
Phone (903) 526-0444

Other practice location 1

3415 Golden Rd
Tyler, TX 75701-8355
Phone (903) 526-0444

Other names 1

  • Heaton Eye Assoicates Optical Shop Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171213001390 TX DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 1557257615 Practice locations: Tyler, TX

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Heaton Eye Associates Optical Shop3415 Golden Rd, Tyler, TX 75701-835590352604443162 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Mar 16, 1990

National Provider Directory

National Provider Directory
Tax ID family
Charles L Heaton MD PA5 organizations share this tax ID, including this one
Part of
Charles L Heaton MD PA

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

3355 Earl Campbell Pkwy
Tyler, TX 75701
Phone (903) 526-0444

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759881600000",
    "number": "1124545413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 EARL CAMPBELL PKWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018435",
            "telephone_number": "903-526-0444",
            "fax_number": "903-595-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 EARL CAMPBELL PKWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018435",
            "telephone_number": "903-526-0444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3415 Golden Rd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757018355",
            "country_code": "US",
            "telephone_number": "903-526-0444",
            "fax_number": "903-526-2051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHARLES L. HEATON , M.D. P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES L. HEATON , M.D. P.A.",
        "enumeration_date": "2017-08-28",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A",
        "authorized_official_last_name": "HODGES-ODOM",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "903-526-0444"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heaton Eye Assoicates Optical Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.