Healthcare Provider Details

I. General information

NPI: 1588781108
Provider Name (Legal Business Name): CAPE FEAR EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 OWEN DR
FAYETTEVILLE NC
28304-3456
US

IV. Provider business mailing address

1629 OWEN DR
FAYETTEVILLE NC
28304-3456
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-2284
  • Fax: 910-323-5081
Mailing address:
  • Phone: 910-484-2284
  • Fax: 910-323-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number351
License Number StateNC

VIII. Authorized Official

Name: TERESA M COX
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 910-484-2284