NPIMap

Organization Active NPI

Charles P. Lawless, M.D., P.a.

Doing business as Walt's Optical Shop

  • Specialist
  • Pocatello, ID
National Provider Identifier
1629280359
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M-3434 Issued in ID
Legal business name
CHARLES P. LAWLESS, M.D., P.A.
Doing business as
Walt's Optical Shop
Practice address
1777 E Clark St Ste 310
Pocatello, ID 83201-3357
Phone
(208) 232-4133
Fax
(208) 233-5736
NPI assigned
May 4, 2007
Last updated
Dec 3, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

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

Authorized official

Name
Dr. Charles Pittman Lawless, M.D.NPI 1205895208
Title
President
Phone
(208) 232-4133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X M-3434 ID Primary

Addresses

Primary practice location

1777 E Clark St Ste 310
Pocatello, ID 83201-3357

Mailing address

1777 E Clark St Ste 310
Pocatello, ID 83201-3357
Phone (208) 232-4133

Other names 1

  • WALT'S OPTICAL SHOP Doing business as

National Provider Directory

National Provider Directory

Locations

1777 E Clark St
Ste 310
Pocatello, ID 83201
Phone (208) 232-4133

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1629280359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 E CLARK ST STE 310",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013357",
            "telephone_number": "208-232-4133",
            "fax_number": "208-233-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 E CLARK ST STE 310",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013357",
            "telephone_number": "208-232-4133",
            "fax_number": "208-233-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES P. LAWLESS, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "LAWLESS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "PITTMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-232-4133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-3434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALT'S OPTICAL SHOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.