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General NPI Number Information
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NPI Number | 1710176979
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Entity Type | Organization
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Legal Business Name | ALDRIDGE EYE INSTITUTE, OD, PA
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 419 E MAIN ST
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City | BURNSVILLE
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State | NC
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Zip | 28714-3050
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Country | US
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Telephone | 828-682-2104
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Fax | 828-682-4217
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Provider Business Mailing Address
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Address Line | PO BOX 218 419 EAST MAIN STREET
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City | BURNSVILLE
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State | NC
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Zip | 28714-0218
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Country | US
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Telephone | 828-682-2104
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Fax | 828-682-4217
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | EILEEN MARIE BLACK
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Credential |
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Telephone | 828-682-2104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1015
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License Number State | NC
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