Provider Demographics
NPI:1922013168
Name:WESTERN WAKE EYE CENTER PA
Entity Type:Organization
Organization Name:WESTERN WAKE EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:919-233-2020
Mailing Address - Street 1:400 ASHVILLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6134
Mailing Address - Country:US
Mailing Address - Phone:919-233-2020
Mailing Address - Fax:919-859-5258
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-233-2020
Practice Address - Fax:919-859-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC180000508OtherMEDICARE RR
NC7902015Medicaid
NC1306Medicare PIN
NC7902015Medicaid
NCC87948Medicare UPIN