Provider Demographics
NPI:1548289010
Name:MCMASTERS, CHARLES EDWIN (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWIN
Last Name:MCMASTERS
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8017
Mailing Address - Country:US
Mailing Address - Phone:601-992-1010
Mailing Address - Fax:601-992-7700
Practice Address - Street 1:120 PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8017
Practice Address - Country:US
Practice Address - Phone:601-992-1010
Practice Address - Fax:601-992-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS530152W00000X
LA997152W00000X
TX3504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08277878Medicaid
MS410048020OtherRR MEDICARE
MS5539OtherDAVIS VISION
MS640935907AOtherNISSAN, BCBS OF TENN.
MS640935907AOtherNISSAN, BCBS OF TENN.
MS08277878Medicaid