MEDICARE: TRIANGLE EYE CONSTITUENTS, LLC

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1205510799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIANGLE EYE CONSTITUENTS, LLC

Provider Business Mailing Address
First Line	:	7512 KARLEY CT
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-5901
Country	:	US
Telephone Number	:	803-517-1060
Fax Number	:

Provider Business Practice Location Address
First Line	:	9650 BRIER CREEK PKWY STE 103
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-6504
Country	:	US
Telephone Number	:	803-200-2071
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER OFFICER
Name	:	KEVIN NUSZ
Credential	:	MD
Telephone Number	:	803-517-1060

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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