Active NPI
Charles Kirk Howard, OD
- Optometrist
- Crestview, FL
National Provider Identifier
1942204938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0001157
- Practice address
- 2491 S Ferdon Blvd
Crestview, FL 32536-8463 - Phone
- (850) 682-4014
- Fax
- (850) 682-0387
- NPI assigned
- Jun 8, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0001157 | FL | Primary |
Addresses
Primary practice location
2491 S Ferdon Blvd
Crestview, FL 32536-8463
Mailing address
2491 S Ferdon Blvd
Crestview, FL 32536-8463
Phone (850) 682-4014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19395 | Other | FL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0001157 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206576000000",
"number": "1942204938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2491 S FERDON BLVD",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325368463",
"telephone_number": "850-682-4014",
"fax_number": "850-682-0387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2491 S FERDON BLVD",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325368463",
"telephone_number": "850-682-4014",
"fax_number": "850-682-0387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOWARD",
"first_name": "CHARLES",
"middle_name": "KIRK",
"name_prefix": "Mr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-08",
"last_updated": "2008-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "0001157",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "19395",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.