MEDICARE: ZACHARY ROBERT ENGLE 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	2276	NC

General Provider Information

NPI Number	:	1912257247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY ROBERT ENGLE O.D.

Provider Business Mailing Address
First Line	:	4351 THE CIRCLE AT NORTH HILLS ST
Second Line	:	STE 107
City	:	RALEIGH
State	:	NC
Zip	:	27609-5751
Country	:	US
Telephone Number	:	919-782-9091
Fax Number	:	919-782-9135

Provider Business Practice Location Address
First Line	:	419 CROSS CREEK MALL
Second Line	:	STE 302
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7285
Country	:	US
Telephone Number	:	919-782-9091
Fax Number	:	919-782-9135

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	10/30/2017

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