Provider Demographics
NPI:1548410665
Name:NORTH RALEIGH FAMILY EYECARE, INC.
Entity Type:Organization
Organization Name:NORTH RALEIGH FAMILY EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANNIE
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-870-6116
Mailing Address - Street 1:10224 DURANT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6468
Mailing Address - Country:US
Mailing Address - Phone:919-870-6116
Mailing Address - Fax:919-870-9892
Practice Address - Street 1:10224 DURANT RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6468
Practice Address - Country:US
Practice Address - Phone:919-870-6116
Practice Address - Fax:919-870-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2328829AMedicare PIN