MEDICARE: VISION CLINIC OD PA

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	2105	NC

General Provider Information

NPI Number	:	1598135691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION CLINIC OD PA

Provider Business Mailing Address
First Line	:	1270 SILVER BEACH WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-4889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 FAYETTEVILLE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3614
Country	:	US
Telephone Number	:	919-961-1115
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMJAD MINWER BADWAN
Credential	:	O.D.
Telephone Number	:	919-961-1115

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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Directions to “VISION CLINIC OD PA ” Practice Location

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