Provider Demographics
NPI:1043377948
Name:PAUL, EDWARD LEE JR (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEE
Last Name:PAUL
Suffix:JR
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 MILITARY CUTOFF RD STE 230
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5745
Mailing Address - Country:US
Mailing Address - Phone:910-256-6364
Mailing Address - Fax:910-256-6617
Practice Address - Street 1:1613 MILITARY CUTOFF RD STE 230
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5745
Practice Address - Country:US
Practice Address - Phone:910-256-6364
Practice Address - Fax:910-256-6617
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246507HOtherMEDICARE PERF PROV #
NC246507HMedicare PIN
NCT65034Medicare UPIN
NC2334026Medicare ID - Type Unspecified