Provider Demographics
NPI:1790388973
Name:CKFOGLEMAN OD, PLLC
Entity type:Organization
Organization Name:CKFOGLEMAN OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:KALEEL
Authorized Official - Last Name:FOGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-791-6086
Mailing Address - Street 1:3216 RED BERRY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2522
Mailing Address - Country:US
Mailing Address - Phone:704-778-1172
Mailing Address - Fax:
Practice Address - Street 1:1205 FLORAL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6216
Practice Address - Country:US
Practice Address - Phone:910-791-6086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center