Organization
DR. CHARLES R. PRUDEN JR. OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ROY PRUDEN JR. OD (OPTOMETRIST)
(252) 237-9191
Entity
Organization
Contact information
Practice address
211 VANCE ST E, WILSON, NC 27893-4117
(252) 237-9191
(252) 237-3918
Mailing address
PO BOX 757, WILSON, NC 27894-0757
(252) 237-9191
(252) 237-3918
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
746
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245232826
INDIVIDUAL NPI
NC
05
—
8909730
—
NC
Enumeration date
11/23/2011
Last updated
11/28/2011
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