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General NPI Number Information
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NPI Number | 1396920955
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Entity Type | Organization
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Legal Business Name | ERIC J. OBERDORF, O.D., P.A.
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 7200 CREEDMOOR RD. SUITE 100
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City | RALEIGH
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State | NC
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Zip | 27613
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Country | US
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Telephone | 919-847-9751
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Fax | 919-676-3918
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Provider Business Mailing Address
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Address Line | 7200 CREEDMOOR RD. SUITE 100
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City | RALEIGH
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State | NC
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Zip | 27613
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Country | US
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Telephone | 919-847-9751
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Fax | 919-676-3918
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ERIC JON OBERDORF
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Credential | OD
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Telephone | 919-847-9751
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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 | 1645
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License Number State | NC
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