Provider Demographics
NPI:1407932551
Name:NEGRUT, COSMIN (OD)
Entity Type:Individual
Prefix:DR
First Name:COSMIN
Middle Name:
Last Name:NEGRUT
Suffix:
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 1:3476 VALLEY ARBORS DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9806
Mailing Address - Country:US
Mailing Address - Phone:828-446-6569
Mailing Address - Fax:
Practice Address - Street 1:2435 US HIGHWAY 70 SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8301
Practice Address - Country:US
Practice Address - Phone:828-326-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901856Medicaid
NC093UNOtherBC BS OF NC PROVIDER ID
NC2473745Medicare ID - Type Unspecified
NC5901856Medicaid