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NPI Code Detail

MEDICARE: THERESA ANN ALDRIDGE O.D.

MEDICARE: THERESA ANN ALDRIDGE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC 1896FL

General Provider Information

NPI Number : 1891752754
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA ANN ALDRIDGE O.D.
Provider Business Mailing Address
First Line : PO BOX 15349
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32317-5349
Country : US
Telephone Number : 850-383-3322
Fax Number : 850-383-3357
Provider Business Practice Location Address
First Line : 1491 GOVERNORS SQUARE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-3049
Country : US
Telephone Number : 850-383-3322
Fax Number : 850-383-3357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 07/08/2007

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