Provider Demographics
NPI:1801845813
Name:SAMUELS, STUART L (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:L
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6893
Mailing Address - Country:US
Mailing Address - Phone:919-233-8500
Mailing Address - Fax:919-233-9783
Practice Address - Street 1:229 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-233-8500
Practice Address - Fax:919-233-9783
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09793OtherBCBS PIN
NCT64886Medicare UPIN
NC246344AMedicare PIN