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General NPI Number Information
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NPI Number | 1023144383
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Entity Type | Individual
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Provider Name | JAMES LOUIS FANELLI OPTOMETRIST
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 5526B CAROLINA BEACH RD
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City | WILMINGTON
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State | NC
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Zip | 28412-2606
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Country | US
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Telephone | 910-452-7225
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Fax | 910-452-7229
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Provider Business Mailing Address
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Address Line | 5526B CAROLINA BEACH RD
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City | WILMINGTON
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State | NC
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Zip | 28412-2606
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Country | US
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Telephone | 910-452-7225
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Fax | 910-452-7229
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1188
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License Number State | NC
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