MEDICARE: DR. RAYMOND J LEGEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	958	NC

General Provider Information

NPI Number	:	1154470201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND J LEGEN O.D.

Provider Business Mailing Address
First Line	:	12720 LINDLEY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-9669
Country	:	US
Telephone Number	:	919-846-0991
Fax Number	:	919-870-8339

Provider Business Practice Location Address
First Line	:	5108 N ROXBORO ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-1420
Country	:	US
Telephone Number	:	919-477-9113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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