Provider Demographics
NPI:1285672774
Name:BLOODWORTH, ALLISON W (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:W
Last Name:BLOODWORTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3901 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6712
Mailing Address - Country:US
Mailing Address - Phone:910-395-2772
Mailing Address - Fax:910-799-9170
Practice Address - Street 1:3901 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6712
Practice Address - Country:US
Practice Address - Phone:910-395-2772
Practice Address - Fax:910-799-9170
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0908TOtherBLUE CROSS BLUE SHIELD NC PTAN
NCU73556Medicare UPIN