Healthcare Provider Details

I. General information

NPI: 1336140730
Provider Name (Legal Business Name): CHARLES HAROLD ALDRIDGE JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E MAIN ST
BURNSVILLE NC
28714-3050
US

IV. Provider business mailing address

419 E MAIN ST PO BOX 218
BURNSVILLE NC
28714-3050
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-2104
  • Fax: 828-682-4217
Mailing address:
  • Phone: 828-682-2104
  • Fax: 828-682-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1015
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: