Provider Demographics
NPI:1457787012
Name:ALDRICH, MATTHEW CHRISTOPHER (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:ALDRICH
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 1:2402 MONTGOMERY DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4421
Mailing Address - Country:US
Mailing Address - Phone:252-243-2020
Mailing Address - Fax:252-291-2020
Practice Address - Street 1:2402 MONTGOMERY DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4421
Practice Address - Country:US
Practice Address - Phone:252-243-2020
Practice Address - Fax:252-291-2020
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457787012Medicaid