Provider Demographics
NPI:1598269326
Name:RTP VISION OD PA
Entity Type:Organization
Organization Name:RTP VISION OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-572-6771
Mailing Address - Street 1:2125 THORNBLADE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-6438
Mailing Address - Country:US
Mailing Address - Phone:704-890-6811
Mailing Address - Fax:
Practice Address - Street 1:8210 RENAISSANCE PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6688
Practice Address - Country:US
Practice Address - Phone:919-572-6771
Practice Address - Fax:919-572-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty