Provider Demographics
NPI:1710176979
Name:ALDRIDGE EYE INSTITUTE, OD, PA
Entity Type:Organization
Organization Name:ALDRIDGE EYE INSTITUTE, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-682-2104
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:419 EAST MAIN STREET
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-0218
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09016OtherBLUE CROSS BLUE SHIELD
NC7909016Medicaid
NC5950031Medicaid
NC5909234Medicaid
NC2346584Medicare PIN
NC09016OtherBLUE CROSS BLUE SHIELD
NC5909234Medicaid
NC0126650001Medicare NSC