Provider Demographics
NPI:1386693257
Name:KNUDSON, CHARLES M (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:KNUDSON
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:15640 JOHN J DELANEY DR
Mailing Address - Street 2:STE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3176
Mailing Address - Country:US
Mailing Address - Phone:704-943-5110
Mailing Address - Fax:704-943-4449
Practice Address - Street 1:15640 JOHN J DELANEY DR
Practice Address - Street 2:STE C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3176
Practice Address - Country:US
Practice Address - Phone:704-943-5110
Practice Address - Fax:704-943-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MK0098358OtherDEA
NCNC9783B884Medicare PIN