MEDICARE: CKFOGLEMAN OD, PLLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1790388973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CKFOGLEMAN OD, PLLC

Provider Business Mailing Address
First Line	:	3216 RED BERRY DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-2522
Country	:	US
Telephone Number	:	704-778-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 FLORAL PKWY
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6216
Country	:	US
Telephone Number	:	910-791-6086
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CAROLINE KALEEL FOGLEMAN
Credential	:	OD
Telephone Number	:	910-791-6086

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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