Healthcare Provider Details

I. General information

NPI: 1356529960
Provider Name (Legal Business Name): PEC OPTOMETRY GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W MAIN ST
BENSON NC
27504-1343
US

IV. Provider business mailing address

113 W MAIN ST
BENSON NC
27504-1343
US

V. Phone/Fax

Practice location:
  • Phone: 919-894-7570
  • Fax: 919-894-4674
Mailing address:
  • Phone: 919-894-7570
  • Fax: 919-894-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ROY M. RAYNOR JR.
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 919-894-7570