Provider Demographics
NPI:1699894204
Name:WARD, P. NEIL (OD)
Entity type:Individual
Prefix:
First Name:P. NEIL
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:NC
Mailing Address - Zip Code:27325-0909
Mailing Address - Country:US
Mailing Address - Phone:910-948-3711
Mailing Address - Fax:910-948-4458
Practice Address - Street 1:300 S MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:NC
Practice Address - Zip Code:27325-8407
Practice Address - Country:US
Practice Address - Phone:910-948-3711
Practice Address - Fax:910-948-4458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09734OtherBLUE CROSS BLUE SHIELD
NC8909734Medicaid
NC8909734Medicaid
NC09734OtherBLUE CROSS BLUE SHIELD
NC2467438Medicare PIN