MEDICARE: DR. DEMETRIAN IVAN DORNIC M.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	207W00000X	Ophthalmology Physician	9800513	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881740090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEMETRIAN IVAN DORNIC M.D.

Provider Business Mailing Address
First Line	:	3701 NW CARY PKWY
Second Line	:	SUITE 101
City	:	CARY
State	:	NC
Zip	:	27513-8431
Country	:	US
Telephone Number	:	919-467-9955
Fax Number	:	919-467-2544

Provider Business Practice Location Address
First Line	:	3701 NW CARY PKWY
Second Line	:	SUITE 101
City	:	CARY
State	:	NC
Zip	:	27513-8431
Country	:	US
Telephone Number	:	919-467-9955
Fax Number	:	919-467-2544

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/09/2007

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