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General NPI Number Information
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NPI Number | 1235468513
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Entity Type | Organization
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Legal Business Name | RETINA INSTITUTE OF NORTH CAROLINA, PC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 3211 ROGERS RD STE 101
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City | WAKE FOREST
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State | NC
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Zip | 27587-3890
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Country | US
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Telephone | 919-453-1462
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Fax | 919-453-1473
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Provider Business Mailing Address
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Address Line | 2605 BLUE RIDGE RD STE 220
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City | RALEIGH
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State | NC
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Zip | 27607-6475
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Country | US
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Telephone | 919-787-8555
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Fax | 919-787-8112
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA FOGEL
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Credential | MD
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Telephone | 919-787-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2006-00726
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License Number State | NC
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