Healthcare Provider Details

I. General information

NPI: 1700779360
Provider Name (Legal Business Name): NIJA SUNIL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAWMILL RD
RALEIGH NC
27615-6148
US

IV. Provider business mailing address

101 SAWMILL RD
RALEIGH NC
27615-6148
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-0051
  • Fax: 919-307-8994
Mailing address:
  • Phone: 919-847-0051
  • Fax: 919-307-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2896
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: