=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043412406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RALEIGH OPHTHALMIC CONSULTANTS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 06/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2709 BLUE RIDGE RD SUITE 100
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-782-5400
-----------------------------------------------------
Fax | 919-782-1680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2709 BLUE RIDGE RD SUITE 100
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-782-5400
-----------------------------------------------------
Fax | 919-782-1680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | ELIZABETH P PARROTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-782-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------