Provider Demographics
NPI:1992925911
Name:JOBE, CHARLES LEWIS
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEWIS
Last Name:JOBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13909 MERIDIAN E STE A4
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9180
Mailing Address - Country:US
Mailing Address - Phone:253-848-2338
Mailing Address - Fax:253-848-5543
Practice Address - Street 1:13909 MERIDIAN E STE A4
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-9180
Practice Address - Country:US
Practice Address - Phone:253-848-2338
Practice Address - Fax:253-848-5543
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWI3145OtherREGENCE
WAWI3145OtherREGENCE