Healthcare Provider Details

I. General information

NPI: 1205819547
Provider Name (Legal Business Name): OPTOMETRIC EYE CARE CENTER OF DURHAM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 W CLUB BLVD
DURHAM NC
27701-1115
US

IV. Provider business mailing address

1058 W CLUB BLVD
DURHAM NC
27701-1104
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-7732
  • Fax: 919-286-3451
Mailing address:
  • Phone: 919-286-7732
  • Fax: 919-286-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH R HOFFMAN
Title or Position: DOCTOR OF OPTOMETRIC OWNER
Credential: OD
Phone: 919-286-7732