Provider Demographics
NPI:1710173083
Name:PRIDGEN, JULIA ANNE (OD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:PRIDGEN
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 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:1975 HIGH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8452
Practice Address - Country:US
Practice Address - Phone:919-461-0771
Practice Address - Fax:919-481-0645
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907927Medicaid
NC0933POtherBCBS NC
NC44098OtherRAILROAD MEDICARE
NC0933POtherBCBS NC
NC2474395CMedicare PIN
NC2474395HMedicare PIN
NC2474395GMedicare PIN
NC2474395JMedicare PIN
NC2474395BMedicare PIN
NC2467603RMedicare PIN
NC2474395FMedicare PIN