Provider Demographics
NPI:1073584157
Name:RISK OPTOMETRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:RISK OPTOMETRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:RISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-868-3910
Mailing Address - Street 1:216 NORTHSTONE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3478
Practice Address - Country:US
Practice Address - Phone:910-868-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0233LOtherBCBS OF NC
NC0233LOtherUNITED HEALTHCARE
NC890233LMedicaid
NC=========OtherTRICARE
NC0233LOtherBCBS OF NC