Provider Demographics
NPI:1003235508
Name:RALEIGH EYE CENTER, PA
Entity Type:Organization
Organization Name:RALEIGH EYE CENTER, PA
Other - Org Name:RALEIGH EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-876-2427
Mailing Address - Street 1:3320 EXECUTIVE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7445
Mailing Address - Country:US
Mailing Address - Phone:919-876-2427
Mailing Address - Fax:919-790-8423
Practice Address - Street 1:129 E FERRELL ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2101
Practice Address - Country:US
Practice Address - Phone:464-447-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALEIGH EYE CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-11
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902857675OtherPRIMARY NPI