Provider Demographics
NPI:1053416040
Name:TEATERS, CHARLES HOUSTON (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOUSTON
Last Name:TEATERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 CARROLLTON PIKE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3668
Mailing Address - Country:US
Mailing Address - Phone:276-236-0400
Mailing Address - Fax:276-236-0400
Practice Address - Street 1:2851 CARROLLTON PIKE
Practice Address - Street 2:SUITE A-1
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3668
Practice Address - Country:US
Practice Address - Phone:276-236-0400
Practice Address - Fax:276-236-0400
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPENDINGMedicaid
VAPENDINGMedicare ID - Type Unspecified
VAU79343Medicare UPIN