Provider Demographics
NPI:1760842777
Name:WAKE FAMILY EYE CARE OD, PA
Entity Type:Organization
Organization Name:WAKE FAMILY EYE CARE OD, PA
Other - Org Name:CARY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-852-1563
Mailing Address - Street 1:2010 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6614
Mailing Address - Country:US
Mailing Address - Phone:919-852-1563
Mailing Address - Fax:919-852-1564
Practice Address - Street 1:2010 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6614
Practice Address - Country:US
Practice Address - Phone:919-852-1563
Practice Address - Fax:919-852-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty