Provider Demographics
NPI:1194729624
Name:HILDEBRAND, CHARLES ALLYN (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALLYN
Last Name:HILDEBRAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 E WEISGARBER RD
Mailing Address - Street 2:STE 104
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2686
Mailing Address - Country:US
Mailing Address - Phone:865-584-0905
Mailing Address - Fax:865-584-3892
Practice Address - Street 1:1124 E WEISGARBER RD
Practice Address - Street 2:STE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-584-0905
Practice Address - Fax:865-584-3892
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD01240174400000X
TNOD1240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371152Medicaid
TN3597330Medicare PIN
TN3371152Medicare ID - Type Unspecified
TN3943298Medicare PIN
TNV27524Medicare UPIN