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General NPI Number Information
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NPI Number | 1619150141
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Entity Type | Organization
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Legal Business Name | PARK OPHTHALMOLOGY
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 5306 NC HIGHWAY 55 SUITE 102
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City | DURHAM
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State | NC
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Zip | 27713-7812
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Country | US
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Telephone | 919-544-5375
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Fax | 919-544-5829
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Provider Business Mailing Address
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Address Line | 5306 NC HIGHWAY 55 SUITE 102
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City | DURHAM
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State | NC
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Zip | 27713-7812
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Country | US
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Telephone | 919-544-5375
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Fax | 919-544-5829
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BETH R FRIEDLAND
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Credential | M.D.
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Telephone | 919-544-5375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 27794
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License Number State | NC
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