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General NPI Number Information
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NPI Number | 1811024961
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EYECARE OPTOMETRY, PA
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 3701 S MAIN ST
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City | HOPE MILLS
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State | NC
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Zip | 28348-1958
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Country | US
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Telephone | 910-423-0700
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Fax | 910-423-0882
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Provider Business Mailing Address
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Address Line | 3701 S MAIN ST
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City | HOPE MILLS
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State | NC
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Zip | 28348-1958
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Country | US
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Telephone | 910-423-0700
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Fax | 910-423-0882
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ERIC RAYNOR
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Credential | OD
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Telephone | 910-423-0700
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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 | NC1508
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License Number State | NC
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