MEDICARE: THE RALEIGH EYE CENTER

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	156FX1800X	Optician	350	NC

General Provider Information

NPI Number	:	1457314437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RALEIGH EYE CENTER

Provider Business Mailing Address
First Line	:	3320 EXECUTIVE DR
Second Line	:	SUITE 111
City	:	RALEIGH
State	:	NC
Zip	:	27609-7445
Country	:	US
Telephone Number	:	919-876-2485
Fax Number	:	919-850-9284

Provider Business Practice Location Address
First Line	:	3320 EXECUTIVE DR
Second Line	:	SUITE 111
City	:	RALEIGH
State	:	NC
Zip	:	27609-7445
Country	:	US
Telephone Number	:	919-876-2485
Fax Number	:	919-850-9284

Authorized Official
Title or Position	:	OPTICIAN
Name	:	JENNIFER HAWKINS JR.
Credential	:
Telephone Number	:	919-876-2485

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/01/2008

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Directions to “THE RALEIGH EYE CENTER ” Practice Location

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