Healthcare Provider Details

I. General information

NPI: 1730866260
Provider Name (Legal Business Name): CAPE FEAR EYE SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1629 OWEN DR
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-672-5000
  • Fax:
Mailing address:
  • Phone: 910-672-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEO SWIFT
Title or Position: COO
Credential:
Phone: 910-672-5000