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
Phone: (919) 361-2299
Fax: (919) 361-0055
Website:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1023043163 | NPPES |
North Carolina | Other | 410036278 | RAILROAD MEDICARE |
North Carolina | Other | 1223620002 | RAILROAD MEDICARE |
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