Provider Demographics
NPI:1396793477
Name:RAYNOR, ROY MAX JR (OD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:MAX
Last Name:RAYNOR
Suffix:JR
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 1:113 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1343
Mailing Address - Country:US
Mailing Address - Phone:919-894-7570
Mailing Address - Fax:919-894-4674
Practice Address - Street 1:113 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1343
Practice Address - Country:US
Practice Address - Phone:919-894-7570
Practice Address - Fax:919-894-4674
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02478OtherSPECTERA
NC09761OtherBCBS
NC78648OtherMEDCOST
NC0914XOtherBCBS
NC28994OtherCOMMUNITY EYE CARE
NC02478OtherSPECTERA
NC5662210OtherAETNA
NC89093CYMedicaid
NC239061OtherMAMSI
NC8909761Medicaid
NC223887OtherUNITED HEALTHCARE
NC410048209Medicare PIN
NC02478OtherSPECTERA
NC239061OtherMAMSI
NC8909761Medicaid
NCT65025Medicare UPIN
NC246495AMedicare PIN
NC28994OtherCOMMUNITY EYE CARE
NC246495Medicare PIN
NC410020084Medicare PIN
NC246495DMedicare PIN