Provider Demographics
NPI:1285412833
Name:TOMPKINS, CHARON MICKIE
Entity type:Individual
Prefix:
First Name:CHARON
Middle Name:MICKIE
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S WATSON RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3371
Mailing Address - Country:US
Mailing Address - Phone:623-474-6907
Mailing Address - Fax:623-474-6914
Practice Address - Street 1:1060 S WATSON RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3371
Practice Address - Country:US
Practice Address - Phone:623-474-6907
Practice Address - Fax:623-474-6914
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO002342156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician