Provider Demographics
NPI:1154321172
Name:HOLLIS, PETER WRIGHT (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WRIGHT
Last Name:HOLLIS
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:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-0477
Mailing Address - Country:US
Mailing Address - Phone:252-908-1397
Mailing Address - Fax:919-944-0085
Practice Address - Street 1:3320 EXECUTIVE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-876-2427
Practice Address - Fax:919-850-9234
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09414OtherBCBS PROV #
NC8909414Medicaid
NC09414OtherBCBS PROV #
NC8909414Medicaid
NCNCH6870281Medicare PIN