Durham, Susan Licata

Durham, Susan Licata is an individual health care provider with primary practice located at 10207 Cerny St Suite 100, Raleigh NC 27617-7878. She recently has 5 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Low Vision Rehabilitation, Eye and Vision Services Providers / Pediatrics, Eye and Vision Services Providers / Sports Vision, Eye and Vision Services Providers / Vision Therapy. Eye and Vision Services Providers / Pediatrics is her primary health care specialty. Durham, Susan Licata can be contacted via phone (919) 361-2299.

Contact Information

Primary practice address
10207 Cerny St Suite 100 Raleigh NC 27617-7878
Fax: (919) 361-0055
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 1335 North Carolina
Eye and Vision Services Providers / Low Vision Rehabilitation 152WL0500X 1335 North Carolina
Eye and Vision Services Providers / Pediatrics 152WP0200X 1335 North Carolina
Eye and Vision Services Providers / Sports Vision 152WS0006X 1335 North Carolina
Eye and Vision Services Providers / Vision Therapy 152WV0400X 1335 North Carolina

Profile Details

NPI number 1023043163
LBN Legal business name Durham, Susan Licata
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Sep 29th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023043163 NPPES
North Carolina Other 410036278 RAILROAD MEDICARE
North Carolina Other 1223620002 RAILROAD MEDICARE

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