Provider Demographics
NPI:1932280260
Name:WEEKS, RAPHAEL DIXON (OD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:DIXON
Last Name:WEEKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3222
Mailing Address - Country:US
Mailing Address - Phone:704-878-2660
Mailing Address - Fax:
Practice Address - Street 1:843 N CENTER ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3222
Practice Address - Country:US
Practice Address - Phone:704-878-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890905UMedicaid
NC0807620001Medicare NSC
NC0807620003Medicare NSC
NC2473136Medicare PIN
NC890905UMedicaid