Provider Demographics
NPI:1457474355
Name:ALBERT R MUNN III MD PA
Entity Type:Organization
Organization Name:ALBERT R MUNN III MD PA
Other - Org Name:CAPITAL EYE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:919-834-7341
Mailing Address - Street 1:720 W JONES ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1427
Mailing Address - Country:US
Mailing Address - Phone:919-834-8341
Mailing Address - Fax:919-833-6008
Practice Address - Street 1:720 W JONES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1427
Practice Address - Country:US
Practice Address - Phone:919-834-8341
Practice Address - Fax:919-833-6008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41028261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890154NMedicaid
NC2324942Medicare ID - Type Unspecified
NCE06712Medicare UPIN
NC890154NMedicaid