Provider Demographics
NPI:1205819547
Name:OPTOMETRIC EYE CARE CENTER OF DURHAM PA
Entity Type:Organization
Organization Name:OPTOMETRIC EYE CARE CENTER OF DURHAM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-286-7732
Mailing Address - Street 1:1058 W CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1104
Mailing Address - Country:US
Mailing Address - Phone:919-286-7732
Mailing Address - Fax:919-286-3451
Practice Address - Street 1:1058 W CLUB BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1115
Practice Address - Country:US
Practice Address - Phone:919-286-7732
Practice Address - Fax:919-286-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013EVOtherBCBS
NC0722320001Medicare NSC