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General NPI Number Information
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NPI Number | 1841528213
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Entity Type | Organization
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Legal Business Name | FAMILY EYECARE OF APEX
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 113 SALEM TOWNE CT
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City | APEX
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State | NC
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Zip | 27502-2311
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Country | US
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Telephone | 919-367-8411
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Fax | 919-367-8431
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Provider Business Mailing Address
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Address Line | 113 SALEM TOWNE CT
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City | APEX
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State | NC
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Zip | 27502-2311
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Country | US
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Telephone | 919-367-8411
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Fax | 919-367-8431
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL RICHARD MARINO
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Credential | OD
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Telephone | 919-367-8411
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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 |
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License Number State |
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