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General NPI Number Information
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NPI Number | 1104922210
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Entity Type | Organization
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Legal Business Name | VISION PARK OPTOMETRY, P.A.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 8311 BANDFORD WAY SUITE 105
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City | RALEIGH
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State | NC
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Zip | 27615-2756
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Country | US
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Telephone | 919-870-1880
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Fax | 919-847-4509
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Provider Business Mailing Address
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Address Line | 8311 BANDFORD WAY SUITE 105
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City | RALEIGH
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State | NC
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Zip | 27615-2756
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Country | US
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Telephone | 919-870-1880
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Fax | 919-847-4509
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Authorized Official
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Title or Position | OPTOMETRIST/ CORPORATE PRESIDENT
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Name | DR. ANN GROOMER MOORE
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Credential | O.D.
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Telephone | 919-870-1880
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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 |
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License Number State | NC
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