Provider Demographics
NPI:1104911635
Name:FORSYTH, PAUL GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GREGORY
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6148
Mailing Address - Country:US
Mailing Address - Phone:919-847-0051
Mailing Address - Fax:919-846-9003
Practice Address - Street 1:101 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6148
Practice Address - Country:US
Practice Address - Phone:919-847-0051
Practice Address - Fax:919-846-9003
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104911635OtherNPI
NC2348490OtherGROUP PTAN
NC1831258912OtherGROUP NPI
NC246573COtherPTAN
NC1831258912OtherGROUP NPI