Provider Demographics
NPI:1295037851
Name:WOLDORFF FAMILY OPTOMETRY PA
Entity Type:Organization
Organization Name:WOLDORFF FAMILY OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:LANSING
Authorized Official - Last Name:WOLDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-270-9284
Mailing Address - Street 1:813 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4137
Mailing Address - Country:US
Mailing Address - Phone:919-381-5365
Mailing Address - Fax:919-381-5266
Practice Address - Street 1:813 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4137
Practice Address - Country:US
Practice Address - Phone:919-381-5365
Practice Address - Fax:919-381-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917825Medicaid
B122Medicare PIN