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General NPI Number Information
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NPI Number | 1447462643
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Entity Type | Organization
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Legal Business Name | WAKE OPHTHALMOLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 105 SW CARY PKWY SUITE 200
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City | CARY
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State | NC
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Zip | 27511-5600
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Country | US
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Telephone | 919-467-4500
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Fax | 919-460-9339
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Provider Business Mailing Address
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Address Line | 105 SW CARY PKWY SUITE 200
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City | CARY
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State | NC
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Zip | 27511-5600
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Country | US
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Telephone | 919-467-4500
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Fax | 919-460-9339
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHRISTY ROBERTSON MOORE
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Credential |
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Telephone | 919-467-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26998
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License Number State | NC
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