Provider Demographics
NPI:1376586867
Name:BALCH, CHARLES L (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:BALCH
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 1:579 CROSS CREEK MALL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7245
Mailing Address - Country:US
Mailing Address - Phone:910-487-2900
Mailing Address - Fax:910-860-1954
Practice Address - Street 1:579 CROSS CREEK MALL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7245
Practice Address - Country:US
Practice Address - Phone:910-487-2900
Practice Address - Fax:910-860-1954
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909507Medicaid
NC09507OtherBCBSNC PROVIDER ID
NCU52879Medicare UPIN
NC8909507Medicaid