Provider Demographics
NPI:1023144383
Name:FANELLI, JAMES LOUIS (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:FANELLI
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526B CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2606
Mailing Address - Country:US
Mailing Address - Phone:910-452-7225
Mailing Address - Fax:910-452-7229
Practice Address - Street 1:5526B CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2606
Practice Address - Country:US
Practice Address - Phone:910-452-7225
Practice Address - Fax:910-452-7229
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562238345OtherVSP
NC09273OtherBCBS
NC562238345OtherSUPERIOR VISION
NC7909273Medicaid
NC2228835OtherUNITED HEALTHCARE
NC562238345OtherCIGNA
NCP00004683OtherRR MEDICARE
NC09273OtherBCBS
NCT65010Medicare UPIN