Provider Demographics
NPI:1144115742
Name:CHARLES L. HEATON, MD, PA
Entity type:Organization
Organization Name:CHARLES L. HEATON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-526-0444
Mailing Address - Street 1:3355 EARL CAMPBELL PKWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8435
Mailing Address - Country:US
Mailing Address - Phone:903-526-0444
Mailing Address - Fax:
Practice Address - Street 1:2415 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3639
Practice Address - Country:US
Practice Address - Phone:903-526-0444
Practice Address - Fax:903-595-6650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES L. HEATON, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty