Provider Demographics
NPI:1144271222
Name:FOGLEMAN, ERIC R (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:FOGLEMAN
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 1:2160 MIDLAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-3220
Mailing Address - Fax:910-295-0507
Practice Address - Street 1:2160 MIDLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2927
Practice Address - Country:US
Practice Address - Phone:910-295-3220
Practice Address - Fax:910-295-0507
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890929EMedicaid
NC0292120001OtherDMERC
NC0929EOtherBCBS PROVIDER #
NC0929EOtherBCBS PROVIDER #
NC2466750BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #