Provider Demographics
NPI:1629287867
Name:LEON BYRUM OPTICIANS INC
Entity Type:Organization
Organization Name:LEON BYRUM OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAUGHTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:919-832-3927
Mailing Address - Street 1:600 A WADE AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-3121
Mailing Address - Country:US
Mailing Address - Phone:919-832-3927
Mailing Address - Fax:919-832-0538
Practice Address - Street 1:600 A WADE AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-3121
Practice Address - Country:US
Practice Address - Phone:919-832-3927
Practice Address - Fax:919-832-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCB0211156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8801643Medicaid
NC8801643Medicaid