Charles Elliott

Key facts

NPI

1558034538

Entity type

Individual (NPI type 1)

Primary specialty

Optometrist 152W00000X

License

1008-138T (LA)

Practice address

5110 Jefferson Hwy
Harahan, LA 70123-5302

Phone

(504) 818-1463

Fax

(504) 818-2664

NPI assigned

Jul 27, 2021

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 27, 2021.

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1558034538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5110 JEFFERSON HWY",
            "city": "HARAHAN",
            "state": "LA",
            "postal_code": "701235302",
            "telephone_number": "504-818-1463",
            "fax_number": "504-818-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5110 JEFFERSON HWY",
            "city": "HARAHAN",
            "state": "LA",
            "postal_code": "701235302",
            "telephone_number": "504-818-1463",
            "fax_number": "504-818-2664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5110 Jefferson Hwy",
            "address_purpose": "LOCATION",
            "city": "Harahan",
            "state": "LA",
            "postal_code": "701235302",
            "country_code": "US",
            "telephone_number": "504-818-1463",
            "fax_number": "504-818-2664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1008-138T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Harahan, LA · Optometrist in Louisiana