Provider Demographics
NPI:1588694467
Name:BOB MORRIS OPTICIANS, INC.
Entity type:Organization
Organization Name:BOB MORRIS OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:919-783-8868
Mailing Address - Street 1:2601 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6481
Mailing Address - Country:US
Mailing Address - Phone:919-783-8868
Mailing Address - Fax:919-783-4770
Practice Address - Street 1:2601 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6481
Practice Address - Country:US
Practice Address - Phone:919-783-8868
Practice Address - Fax:919-783-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC517332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0870670001Medicare ID - Type UnspecifiedLICENSED OPTICIAN