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General NPI Number Information
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NPI Number | 1467864181
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC EYE TECH PA
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 4431 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1443
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Country | US
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Telephone | 919-212-2355
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Fax | 919-212-2455
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Provider Business Mailing Address
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Address Line | 201 SUMMERWINDS DR
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City | CARY
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State | NC
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Zip | 27518-9640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES E YARBOROUGH JR.
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Credential | OD
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Telephone | 919-859-2215
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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 | 1065
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License Number State | NC
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