Provider Demographics
NPI:1336140730
Name:ALDRIDGE, CHARLES HAROLD JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HAROLD
Last Name:ALDRIDGE
Suffix:JR
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 1:419 E MAIN ST
Mailing Address - Street 2:PO BOX 218
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-3050
Mailing Address - Country:US
Mailing Address - Phone:828-682-2104
Mailing Address - Fax:828-682-4217
Practice Address - Street 1:419 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3050
Practice Address - Country:US
Practice Address - Phone:828-682-2104
Practice Address - Fax:828-682-4217
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561706081OtherTAX ID
NC7909016Medicaid
NC09016OtherBCBSNC
NC0126650001Medicare NSC
NC246322AMedicare ID - Type Unspecified
NCT65073Medicare UPIN