Healthcare Provider Details

I. General information

NPI: 1346385168
Provider Name (Legal Business Name): JANE S OGAWA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2516
US

IV. Provider business mailing address

123 GLEN HAVEN DR
CHAPEL HILL NC
27516-4044
US

V. Phone/Fax

Practice location:
  • Phone: 919-593-0905
  • Fax: 919-765-0013
Mailing address:
  • Phone: 919-593-0905
  • Fax: 919-967-9804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC1870
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: