Dr. Charles R. Pruden Jr. OD

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

746 Issued in NC

Legal business name

DR. CHARLES R. PRUDEN JR. OD

Practice address

211 Vance St E
Wilson, NC 27893-4117

Phone

(252) 237-9191

Fax

(252) 237-3918

NPI assigned

Nov 23, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles Roy Pruden Jr., OD

Title

Optometrist

Phone

(252) 237-9191

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1669749388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 757",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278940757",
            "telephone_number": "252-237-9191",
            "fax_number": "252-237-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 VANCE ST E",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934117",
            "telephone_number": "252-237-9191",
            "fax_number": "252-237-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. CHARLES R. PRUDEN JR. OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-23",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "PRUDEN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "252-237-9191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NC",
            "license": "746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1245232826",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909730",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lacey Dawn Dlugos
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• Dove Healthcare, Inc.
• Dr John Q Watson DDS Msco PA
• Kim Drayton
• Shannon Drohan, M.D.
• DRS Linville & Watson
• Dudley B. Anderson, M.D., P.a.
• Amy Ludwick Dunn, CRNA

• Eyewear Supplier in Wilson, NC
• Providers in Wilson, NC by specialty
• Eyewear Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.