Provider Demographics
NPI:1255606596
Name:BALDINGER, MICHAEL D (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:BALDINGER
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 1:1208 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4208
Mailing Address - Country:US
Mailing Address - Phone:704-392-2020
Mailing Address - Fax:704-399-8029
Practice Address - Street 1:1208 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4208
Practice Address - Country:US
Practice Address - Phone:704-392-2020
Practice Address - Fax:704-399-8029
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920037Medicaid
NCNC5840AMedicare PIN