Healthcare Provider Details

I. General information

NPI: 1962456343
Provider Name (Legal Business Name): CAPE FEAR EYE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 METRO MEDICAL DR
FAYETTEVILLE NC
28304-3861
US

IV. Provider business mailing address

1726 METRO MEDICAL DR
FAYETTEVILLE NC
28304-3861
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-2284
  • Fax: 910-484-0458
Mailing address:
  • Phone: 910-484-2284
  • Fax: 910-484-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA A MADISON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 910-484-2284