=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003235508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RALEIGH EYE CENTER, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2014
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 E FERRELL ST
-----------------------------------------------------
City | SOUTH HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23970-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 464-447-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3320 EXECUTIVE DR SUITE 111
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-7445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-876-2427
-----------------------------------------------------
Fax | 919-790-8423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | LESLIE R ARNOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-876-2427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------