Provider Demographics
NPI:1154758670
Name:HERRING, AGEN J (OD)
Entity type:Individual
Prefix:DR
First Name:AGEN
Middle Name:J
Last Name:HERRING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1525 BENVENUE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6383
Mailing Address - Country:US
Mailing Address - Phone:252-557-2257
Mailing Address - Fax:252-972-0003
Practice Address - Street 1:1525 BENVENUE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6383
Practice Address - Country:US
Practice Address - Phone:252-557-2257
Practice Address - Fax:252-972-0003
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC47-1497698OtherTAX ID
NC2335OtherLICENSE
NC12587847OtherCAQH