| |
11081 Wake Forest Drive, Suite112, Raleigh, NC 27614-7655 | |
(252) 231-0424 | |
(252) 231-0580 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 11081 Wake Forest Drive, Raleigh, North Carolina |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467413617 | NPI | - | NPPES |
890285G | Medicaid | NC | |
0285G | Other | NC | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Provider Name | Odette Margit Houghton |
---|---|
Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1205873791 PECOS PAC ID: 0547233652 Enrollment ID: I20061026000536 |
Provider Name | Susan Watson |
---|---|
Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1184685646 PECOS PAC ID: 0648216697 Enrollment ID: I20100111000361 |
Mailing Address | Practice Location Address |
---|---|
512 Shady Circle Drive, Rocky Mount, NC 27803-1715 Ph: (252) 231-0424 | 11081 Wake Forest Drive, Suite112, Raleigh, NC 27614-7655 Ph: (252) 231-0424 |