MEDICARE: NORTH RALEIGH FAMILY EYECARE, INC.

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	NC1757	NC

General Provider Information

NPI Number	:	1548410665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH RALEIGH FAMILY EYECARE, INC.

Provider Business Mailing Address
First Line	:	10224 DURANT RD
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27614-6468
Country	:	US
Telephone Number	:	919-870-6116
Fax Number	:	919-870-9892

Provider Business Practice Location Address
First Line	:	10224 DURANT RD
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27614-6468
Country	:	US
Telephone Number	:	919-870-6116
Fax Number	:	919-870-9892

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANNIE SOOK GRIFFIN
Credential	:
Telephone Number	:	919-870-6116

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	12/21/2010

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