Provider Demographics
NPI:1396920955
Name:ERIC J. OBERDORF, O.D., P.A.
Entity type:Organization
Organization Name:ERIC J. OBERDORF, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JON
Authorized Official - Last Name:OBERDORF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-847-9751
Mailing Address - Street 1:7200 CREEDMOOR RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613
Mailing Address - Country:US
Mailing Address - Phone:919-847-9751
Mailing Address - Fax:919-676-3918
Practice Address - Street 1:7200 CREEDMOOR RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613
Practice Address - Country:US
Practice Address - Phone:919-847-9751
Practice Address - Fax:919-676-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5346700001Medicare NSC
NC2337289Medicare PIN
NCU98876Medicare UPIN