Provider Demographics
NPI:1164532297
Name:ALLGOOD, CHARLES D (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:ALLGOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2332
Mailing Address - Country:US
Mailing Address - Phone:205-926-4816
Mailing Address - Fax:205-926-5688
Practice Address - Street 1:260 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2332
Practice Address - Country:US
Practice Address - Phone:205-926-4816
Practice Address - Fax:205-926-5688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-374-TA-005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS-374-TA-005OtherAL LICENSE
AL000059437Medicaid
AL63-0782398OtherFEDERAL TAX ID
AL406183603Medicare PIN
AL000059437Medicaid
ALT-68308Medicare UPIN
AL000059437Medicare PIN