Provider Demographics
NPI:1295916732
Name:WAKE FOREST FAMILY EYE CARE, O.D., P.A.
Entity type:Organization
Organization Name:WAKE FOREST FAMILY EYE CARE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-556-1909
Mailing Address - Street 1:110 CAPCOM AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6531
Mailing Address - Country:US
Mailing Address - Phone:919-556-1909
Mailing Address - Fax:919-556-6765
Practice Address - Street 1:110 CAPCOM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6531
Practice Address - Country:US
Practice Address - Phone:919-556-1909
Practice Address - Fax:919-556-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246489EMedicare PIN
NC6234720001Medicare NSC