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General NPI Number Information
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NPI Number | 1396860029
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Entity Type | Organization
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Legal Business Name | EYEDEALS OPTOMETRY, PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6085 CAPITAL BLVD
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City | RALEIGH
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State | NC
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Zip | 27616-2941
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Country | US
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Telephone | 919-877-9300
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Fax | 919-877-9335
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Provider Business Mailing Address
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Address Line | 6085 CAPITAL BLVD
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City | RALEIGH
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State | NC
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Zip | 27616-2941
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Country | US
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Telephone | 919-877-9300
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Fax | 919-877-9335
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD L BLACK
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Credential | O.D.
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Telephone | 919-877-9300
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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 | NC1312
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License Number State | NC
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