Provider Demographics
NPI:1780953406
Name:FERRAZZO, PHILIP R (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:R
Last Name:FERRAZZO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:SUITE 131
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-322-0773
Mailing Address - Fax:919-615-0456
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 131
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-322-0773
Practice Address - Fax:919-615-0456
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2015-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1987156FX1800X
NY3776156FX1800X
FL1410156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician