Provider Demographics
NPI:1316963184
Name:KEYLON, CHARLES DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:KEYLON
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:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0826
Mailing Address - Country:US
Mailing Address - Phone:423-745-8882
Mailing Address - Fax:423-744-8428
Practice Address - Street 1:902 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3432
Practice Address - Country:US
Practice Address - Phone:423-745-8882
Practice Address - Fax:423-744-8428
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN22279OtherBLUE CROSS BLUE SHIELD TN
TN3592363Medicaid
TN410037383OtherMEDICARE RAILROAD
TN14981OtherSPECTERA
TN0350810001OtherDMERC
TN2240023OtherUNITED HEALTHCARE
TN5053443OtherCIGNA
TN2240023OtherUNITED HEALTHCARE
TN410037383OtherMEDICARE RAILROAD