Charles Collard, O.D.
Individual provider Active NPI Optometrist · Center, TX
NPI 1679646244 · NPPES record last updated Oct 1, 2012
Key facts
- NPI
- 1679646244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 5053TG (TX)
- Practice address
- 106 Nacogdoches St
Center, TX 75935-3852 - Phone
- (936) 591-0808
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041227000600 | TX | Practitioner - Optometry | 4587622386 | Practice locations: Center, TX |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5053TG | TX | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5053TG | TX | Yes |
Addresses
Primary practice location
106 Nacogdoches St
Center, TX 75935-3852
Mailing address
106 Nacogdoches St
Center, TX 75935-3852
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P0043300082659 | Other | RAILROAD MEDICARE |
Other providers in Center, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.