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General NPI Number Information
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NPI Number | 1598135691
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Entity Type | Organization
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Legal Business Name | VISION CLINIC OD PA
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 4500 FAYETTEVILLE RD
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City | RALEIGH
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State | NC
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Zip | 27603-3614
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Country | US
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Telephone | 919-961-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 SILVER BEACH WAY
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City | RALEIGH
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State | NC
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Zip | 27606-4889
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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 | OWNER
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Name | DR. AMJAD MINWER BADWAN
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Credential | O.D.
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Telephone | 919-961-1115
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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 | 2105
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License Number State | NC
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