Provider Demographics
NPI:1700054897
Name:OPTOMETRIC EYE CARE CENTER OF DURHAM PA
Entity Type:Organization
Organization Name:OPTOMETRIC EYE CARE CENTER OF DURHAM PA
Other - Org Name:DUKE SUPER OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-286-7732
Mailing Address - Street 1:2351 ERWIN RD
Mailing Address - Street 2:DUKE SUPEROPTICS
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4699
Mailing Address - Country:US
Mailing Address - Phone:919-493-3668
Mailing Address - Fax:919-490-5594
Practice Address - Street 1:14 CONSULTANT PL
Practice Address - Street 2:SUITE 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6320
Practice Address - Country:US
Practice Address - Phone:919-493-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTOMETRIC EYE CARE CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0722320002Medicare NSC