Healthcare Provider Details

I. General information

NPI: 1043492788
Provider Name (Legal Business Name): DOMINION EYECARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 W MILLBROOK RD
RALEIGH NC
27609-4304
US

IV. Provider business mailing address

238 W MILLBROOK RD
RALEIGH NC
27609-4304
US

V. Phone/Fax

Practice location:
  • Phone: 919-676-4714
  • Fax: 919-845-2530
Mailing address:
  • Phone: 919-676-4714
  • Fax: 919-845-2530

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 TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL W. HOPKINS SR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-676-4714