Provider Demographics
NPI:1588704340
Name:CARY EYE CENTER OPTOMETRY PA
Entity type:Organization
Organization Name:CARY EYE CENTER OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LICATA
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-467-3238
Mailing Address - Street 1:1398 KILDAIRE FARM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5567
Mailing Address - Country:US
Mailing Address - Phone:919-467-3238
Mailing Address - Fax:919-460-7776
Practice Address - Street 1:1398 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5567
Practice Address - Country:US
Practice Address - Phone:919-467-3238
Practice Address - Fax:919-460-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1335152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC083568695OtherTRICARE
NC410036278OtherRAILROAD MEDICARE
NC0917NOtherBLUE CROSS BLUE SHIELD
NC543199OtherMAMSI
NC5910OtherAVESIS
NC2253547OtherUNITED HEALTH CARE
NC890971NMedicaid
NCB729OtherPARTNERS
NCNC9335OtherVBA
NCU28219Medicare UPIN
NCNC9335OtherVBA
NC890971NMedicaid