Individual
MR. CHARLES E HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
840 N STONE ST, DELAND, FL 32720-3256
(386) 734-1766
(386) 740-7866
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP0002236
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078734500
—
FL
Enumeration date
09/07/2005
Last updated
08/27/2021
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