Provider Demographics
NPI:1144414772
Name:FIRST IN SIGHT OD PLLC
Entity Type:Organization
Organization Name:FIRST IN SIGHT OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SULT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-845-5555
Mailing Address - Street 1:9660 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2473
Mailing Address - Country:US
Mailing Address - Phone:919-845-5555
Mailing Address - Fax:
Practice Address - Street 1:9660 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 142
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2473
Practice Address - Country:US
Practice Address - Phone:919-845-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09885OtherBCBS