MEDICARE: DR. PETER WRIGHT HOLLIS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1008	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09414	OTHER	NC	BCBS PROV #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154321172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER WRIGHT HOLLIS O.D.

Provider Business Mailing Address
First Line	:	PO BOX 477
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-0477
Country	:	US
Telephone Number	:	252-908-1397
Fax Number	:	919-944-0085

Provider Business Practice Location Address
First Line	:	3320 EXECUTIVE DR
Second Line	:	SUITE 111
City	:	RALEIGH
State	:	NC
Zip	:	27609-7445
Country	:	US
Telephone Number	:	919-876-2427
Fax Number	:	919-850-9234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	09/04/2015

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