Healthcare Provider Details

I. General information

NPI: 1730325473
Provider Name (Legal Business Name): APEX VISION CENTER OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 BEAVER CREEK COMMONS DR
APEX NC
27502-3918
US

IV. Provider business mailing address

1049 BEAVER CREEK COMMONS DR
APEX NC
27502-3918
US

V. Phone/Fax

Practice location:
  • Phone: 919-367-7889
  • Fax: 919-249-4079
Mailing address:
  • Phone: 919-367-7889
  • Fax: 919-249-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1711
License Number StateNC

VIII. Authorized Official

Name: DAVID J HOLLER
Title or Position: OPTOMETRIST
Credential:
Phone: 919-367-7889