Provider Demographics
NPI:1346571619
Name:BYNUM, RALEIGH WESLEY SR (OD)
Entity Type:Individual
Prefix:DR
First Name:RALEIGH
Middle Name:WESLEY
Last Name:BYNUM
Suffix:SR
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 1:5237 DOWNING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0367
Mailing Address - Country:US
Mailing Address - Phone:704-596-6270
Mailing Address - Fax:704-921-2854
Practice Address - Street 1:5237 DOWNING CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0367
Practice Address - Country:US
Practice Address - Phone:704-596-6270
Practice Address - Fax:704-921-2854
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist