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General NPI Number Information
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NPI Number | 1326431735
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Entity Type | Organization
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Legal Business Name | CAROLINA OPTOMETRY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 2838 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-7840
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Country | US
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Telephone | 919-755-2814
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Fax | 919-977-6927
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Provider Business Mailing Address
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Address Line | 2838 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-7840
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Country | US
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Telephone | 919-755-2814
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Fax | 919-977-6927
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ANDREW MICHAEL GRAVES
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Credential | O.D.
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Telephone | 919-537-2500
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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 | 2154
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License Number State | NC
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