Provider Demographics
NPI:1336105766
Name:ROCK, PAUL T (OD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:ROCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:101 MARK DR
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1077
Mailing Address - Country:US
Mailing Address - Phone:252-482-7471
Mailing Address - Fax:252-482-5465
Practice Address - Street 1:111 SEACHASE DR
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959
Practice Address - Country:US
Practice Address - Phone:252-441-5911
Practice Address - Fax:252-480-3899
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1605152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
0978AOtherBC
NC890978AMedicaid
0978AOtherBC
U06032Medicare UPIN