Healthcare Provider Details

I. General information

NPI: 1881925378
Provider Name (Legal Business Name): BRIER CREEK VISION CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 BRIER CREEK PKWY STE 107
RALEIGH NC
27617-6504
US

IV. Provider business mailing address

9650 BRIER CREEK PKWY STE 107
RALEIGH NC
27617-6504
US

V. Phone/Fax

Practice location:
  • Phone: 919-361-2299
  • Fax: 919-361-0055
Mailing address:
  • Phone: 919-361-2299
  • Fax: 919-361-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1335
License Number StateNC

VIII. Authorized Official

Name: DR. SUSAN LICATA DURHAM
Title or Position: PRESIDENT
Credential: O.D.
Phone: 919-361-2299