Provider Demographics
NPI:1245246628
Name:BRIDGES, CAROL MOSS (OD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MOSS
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5112
Mailing Address - Country:US
Mailing Address - Phone:828-433-1000
Mailing Address - Fax:828-433-6274
Practice Address - Street 1:1622 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4939
Practice Address - Country:US
Practice Address - Phone:704-482-2020
Practice Address - Fax:704-482-7707
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09100OtherBLUE CROSS BLUE SHIELD NC
NC8909100Medicaid
NC2468015AMedicare PIN
NCU33639Medicare UPIN