Basic Information
Provider Information | |||||||||
NPI: | 1821099425 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RICH | ||||||||
FirstName: | CADMUS | ||||||||
MiddleName: | COLLINS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4102 N ROXBORO RD | ||||||||
Address2: |   | ||||||||
City: | DURHAM | ||||||||
State: | NC | ||||||||
PostalCode: | 27704 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9195952000 | ||||||||
FaxNumber: | 9195952190 | ||||||||
Practice Location | |||||||||
Address1: | 4102 N ROXBORO ST | ||||||||
Address2: |   | ||||||||
City: | DURHAM | ||||||||
State: | NC | ||||||||
PostalCode: | 277042122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9195952000 | ||||||||
FaxNumber: | 9195952190 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/03/2005 | ||||||||
LastUpdateDate: | 10/12/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 9601453 | NC | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 5612887670 | 01 | NC | CIGNA | OTHER | 5556464 | 01 | NC | AETNA | OTHER | 0856311 | 01 | NC | UNITED HEALTHCARE | OTHER | 98509 | 01 | NC | MEDCOST | OTHER | 891028T | 05 | NC |   | MEDICAID | 1028T | 01 | NC | BCBS NC | OTHER | 23356 | 01 | NC | OPTICARE | OTHER | 483533 | 01 | NC | MAMSI | OTHER |