Provider Demographics
NPI:1033138599
Name:DUDLEY, ERIC CLARK (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CLARK
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 SELWYN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3501
Mailing Address - Country:US
Mailing Address - Phone:704-521-2719
Mailing Address - Fax:704-510-0919
Practice Address - Street 1:8701 JW CLAY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5417
Practice Address - Country:US
Practice Address - Phone:704-510-0816
Practice Address - Fax:704-510-0919
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0936130OtherDEA NUMBER
U92941Medicare UPIN