Healthcare Provider Details

I. General information

NPI: 1164532297
Provider Name (Legal Business Name): CHARLES D ALLGOOD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 PIERSON AVE
CENTREVILLE AL
35042-2919
US

IV. Provider business mailing address

223 PIERSON AVE
CENTREVILLE AL
35042-2919
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-4816
  • Fax: 888-803-4916
Mailing address:
  • Phone: 205-926-4816
  • Fax: 205-926-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-374-TA-005
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: