Individual
DR. CHARLES A. WARDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1426 COMMERCE AVE, LONGVIEW, WA 98632-3720
(360) 423-7650
(360) 423-2346
Mailing address
1426 COMMERCE AVE, LONGVIEW, WA 98632-3720
(360) 423-7650
(360) 423-2346
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1115
OR
152W00000X
Optometrist
Primary
907
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2046902
—
WA
01
—
410004815
RAILROAD MEDICARE
WA
Enumeration date
06/29/2005
Last updated
08/06/2010
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