Charles A. Wardle, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

907 Issued in WA

Practice address

1426 Commerce Ave
Longview, WA 98632-3720

Phone

(360) 423-7650

Fax

(360) 423-2346

NPI assigned

Jun 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1120003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281052800000",
    "number": "1649277245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1426 COMMERCE AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323720",
            "telephone_number": "360-423-7650",
            "fax_number": "360-423-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1426 COMMERCE AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323720",
            "telephone_number": "360-423-7650",
            "fax_number": "360-423-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDLE",
        "first_name": "CHARLES",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-29",
        "last_updated": "2010-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "907",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1115",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2046902",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410004815",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michele M. Waltz, LMHC
• Dar Jen Wang
• Min Guang Wang, MD
• Mu-Hsiang Joy Wang, MD
• Kathryn Ward, L.M.P.
• Jacquelyn Wargo
• Paula Clark Warme, LMFT
• Amy Warner, RN
• Brittany M Warning, LMT
• Matthew Warren, BS, R-AAC

• Optometrist in Longview, WA
• Providers in Longview, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; 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.