Provider Demographics
NPI:1225195142
Name:NORTH RALEIGH OPHTHALMOLOGY, P.A.
Entity Type:Organization
Organization Name:NORTH RALEIGH OPHTHALMOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-876-4064
Mailing Address - Street 1:5962 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3895
Mailing Address - Country:US
Mailing Address - Phone:919-876-4064
Mailing Address - Fax:919-876-3159
Practice Address - Street 1:5962 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3895
Practice Address - Country:US
Practice Address - Phone:919-876-4064
Practice Address - Fax:919-876-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15971207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012P3Medicaid
NC89012P3Medicaid
NC2318561Medicare Oscar/Certification