Healthcare Provider Details

I. General information

NPI: 1023546876
Provider Name (Legal Business Name): RALEIGH OPHTHALMIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BLUE RIDGE RD STE 100
RALEIGH NC
27607-6462
US

IV. Provider business mailing address

2709 BLUE RIDGE RD STE 100
RALEIGH NC
27607-6462
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-5400
  • Fax: 919-782-1680
Mailing address:
  • Phone: 919-782-5400
  • Fax: 919-881-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD CLIFT LASKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-782-5400