Provider Demographics
NPI:1588080436
Name:WAKE FAMILY EYE CARE OD, PA
Entity type:Organization
Organization Name:WAKE FAMILY EYE CARE OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-859-0777
Mailing Address - Street 1:155 PARKWAY OFFICE CT
Mailing Address - Street 2:UNIT 105
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7426
Mailing Address - Country:US
Mailing Address - Phone:919-859-0777
Mailing Address - Fax:919-415-0443
Practice Address - Street 1:155 PARKWAY OFFICE CT
Practice Address - Street 2:UNIT 105
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7426
Practice Address - Country:US
Practice Address - Phone:919-859-0777
Practice Address - Fax:919-415-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty