Organization
DR. CHARLES R. PRUDEN JR. OD
Active
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
Update your record
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