Provider Demographics
NPI:1730235375
Name:THOMAS, CHARLES GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GREGORY
Last Name:THOMAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7745 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:SUITE101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2442
Mailing Address - Country:US
Mailing Address - Phone:704-841-3937
Mailing Address - Fax:704-841-3964
Practice Address - Street 1:7745 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:SUITE101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2442
Practice Address - Country:US
Practice Address - Phone:704-841-3937
Practice Address - Fax:704-841-3964
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC05415OtherSPECTERA
NC28916OtherCOMMUNITY EYE CARE
NC093HROtherBCBS
NC28916OtherCOMMUNITY EYE CARE
NC2467135AMedicare ID - Type Unspecified