Charles Walter Hathaway, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC860 Issued in FL

Practice address

255 John Knox Rd
Tallahassee, FL 32303-6676

Phone

(850) 385-0255

Fax

(850) 385-3941

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1720154099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 JOHN KNOX RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323036676",
            "telephone_number": "850-385-0255",
            "fax_number": "850-385-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 JOHN KNOX RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323036676",
            "telephone_number": "850-385-0255",
            "fax_number": "850-385-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "CHARLES",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084900600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Maria Hassan
• Janet L, Hastings
• Hatcher Opticians, Inc.
• Elise Hatfield, PA
• Howard Keith Hatfield, PA-C
• Madeline Smith Hatim, LPN
• Kate McGill Hattaway
• Hattie Morgan House LLC
• Jennifer Hauer, PHARMD
• Coleman Garcia Haughbrook

• Optometrist in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.