Healthcare Provider Details

I. General information

NPI: 1700054897
Provider Name (Legal Business Name): OPTOMETRIC EYE CARE CENTER OF DURHAM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CONSULTANT PL SUITE 100
DURHAM NC
27707-6320
US

IV. Provider business mailing address

2351 ERWIN RD DUKE SUPEROPTICS
DURHAM NC
27705-4699
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-3668
  • Fax:
Mailing address:
  • Phone: 919-493-3668
  • Fax: 919-490-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

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