Basic Information
| Provider Information | |||||||||
| NPI: | 1881646511 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIANGLE EYE INSTITUTE OD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | STE 120 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198810900 | ||||||||
| FaxNumber: | 9198810911 | ||||||||
| Practice Location | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | STE 120 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198810900 | ||||||||
| FaxNumber: | 9198810911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 02/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAID | ||||||||
| AuthorizedOfficialFirstName: | OSAMA | ||||||||
| AuthorizedOfficialMiddleName: | HAMDI | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9198810900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1776 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 018EX | 01 | NC | BCBS | OTHER | 8802086 | 05 | NC | MEDICAID |