DR. SUSAN LICATA DURHAM (NPI# 1023043163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023043163 |
| Entity Type | Individual |
| Full Name | DR. SUSAN LICATA DURHAM |
| Credential | OD |
| Practice Address |
10207 Cerny St Suite 100 Raleigh NC 27617-7878 |
| Practice Telephone | 9193612299 |
| Practice Fax Number | 9193610055 |
| Mailing Telephone | 9193612299 |
| Mailing Fax Number | 9193610055 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-09-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
1335 | NC | Eye and Vision Services Providers |
| N | 152WL0500X |
Optometrist Specialization: Low Vision Rehabilitation |
1335 | NC | Eye and Vision Services Providers |
| Y | 152WP0200X |
Optometrist Specialization: Pediatrics |
1335 | NC | Eye and Vision Services Providers |
| N | 152WS0006X |
Optometrist Specialization: Sports Vision |
1335 | NC | Eye and Vision Services Providers |
| N | 152WV0400X |
Optometrist Specialization: Vision Therapy |
1335 | NC | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | RAILROAD MEDICARE | 410036278 | 01 |
| NC | PALMETTO DMERC | 1223620002 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164539276 | Susan Ray Durham | Pharmacist | 44801 Highway 17, Vernon, AL 35592-0509 | 2006-08-24 |
| 1245247592 | Susan Watson Durham | Anesthesiology | 1227 Carthage St, Sanford, NC 27330-8984 | 2006-08-01 |
| 1134580749 | Susan Carole Durham | Social Worker | 3222 N High St, Columbus, OH 43202-1114 | 2016-03-09 |
| 1841663077 | Susan J. Durham | Registered Nurse | 200 University Rdg, Greenville, SC 29601-3635 | 2015-11-10 |
| 1154587699 | Susan Ashley Durham | Occupational Therapy Assistant | 276 Fountain Ln, Kimberling City, MO 65686-9356 | 2008-08-04 |
| 1568505204 | Susan Durham | Registered Nurse | 9501 Farrell Rd, Fort Belvoir, VA 22060-5901 | 2007-02-14 |
| 1023126968 | Susan W. Durham | Occupational Therapist | 1401 Malvern Ave, Suite 152, Hot Springs, AR 71901-6327 | 2006-08-29 |
| 1619985033 | Susan Renee Durham | Neurological Surgery | 1 Medical Center Dr, Dhmc, Lebanon, NH 03756-1000 | 2006-08-03 |
| Street Address |
10207 CERNY ST SUITE 100 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27617-7878 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104437342 | Bradley James Denmeade | Registered Nurse | 10207 Cerny St, Raleigh, NC 27617-4879 | 2020-08-12 |
| 1891331609 | Lora Darlene M Ray | Dietitian, Registered | 10207 Cerny St, Raleigh, NC 27617-4879 | 2019-11-27 |
| 1629516372 | Duke University | Special Hospital | 10207 Cerny St, Raleigh, NC 27617-4879 | 2017-02-02 |
| 1093190969 | Alexandra Quane Cotter | Physician Assistant | 10207 Cerny St, Suite 312-b, Raleigh, NC 27617-4879 | 2015-07-21 |
| 1669812673 | Barbara Bauer Zickgraf | Dentist | 10207 Cerny St, Suite 106, Raleigh, NC 27617-7878 | 2013-07-05 |
| 1730442138 | Nina Maheshwari Thomas | Dentist | 10207 Cerny St, Suite 106, Raleigh, NC 27617-7878 | 2012-06-20 |
| 1710299375 | Dani Stansell Dds Pa | Dentist | 10207 Cerny St, Ste 106, Raleigh, NC 27617-7878 | 2010-07-11 |
| 1245556877 | Christian Blake Cameron | Internal Medicine | 10207 Cerny St, Suite 306, Raleigh, NC 27617-4879 | 2010-04-07 |
| 1497994529 | Nicole Marie Longoria | Physician Assistant | 10207 Cerny St, Suite 312, Raleigh, NC 27617-4879 | 2009-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285243808 | Maja V Martin Dds Pa II | Clinic/Center | 4203 Corners Pkwy, Ste 100, Raleigh, NC 27617 | 2020-07-29 |
| 1568006310 | Aubrey Nicole Stephenson | Dietitian, Registered | 8801 Fast Park Dr Suite 211, Raleigh, NC 27617 | 2019-11-05 |
| 1982114567 | Method Manual Physical Therapy and Wellness LLC | Physical Therapist | 9244 Miranda Drive, Raleigh, NC 27617 | 2017-10-09 |
| 1588182539 | Aqsa Salman | Counselor | 11736 Dellcain Court, Raleigh, NC 27617 | 2017-08-30 |
| 1962942326 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 10440 Glenwood, Durham, NC 27617 | 2017-03-06 |
| 1457896037 | Emergeortho Pa | Durable Medical Equipment & Medical Supplies | 7850 Brier Creek Parkway, Suites 200, Raleigh, NC 27617 | 2017-01-05 |
| 1033667621 | Hillary Houghton | Nurse Practitioner | 10211 Alm St # 210, Raleigh, NC 27617 | 2016-09-13 |
| 1821449406 | John William Langel | Optometrist | 8851 Ellstree Ln Ste 200, Raleigh, NC 27617 | 2016-06-24 |
| 1821457789 | Acariahealth Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 7231 Acc Blvd Ste 103, Raleigh, NC 27617 | 2016-02-19 |
| 1033583760 | America Alisha Allen | Social Worker | 8610 Brittdale Lane, Apt 307, Raleigh, NC 27617 | 2015-11-18 |
| Find all providers in zip 27617 | ||||
| Taxonomy Code | 152WP0200X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Pediatrics |
| Optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568700714 | Jennifer D Idoni | Optometrist | 16618 Riverstone Way, Charlotte, NC 28277 | 2013-01-23 |
| 1306894407 | Forsyth Memorial Hospital, Inc | Optometrist | 3333 Silas Creek Pkwy, Dba Community Care, Winston Salem, NC 27103-3013 | 2006-05-04 |
Please comment or provide details below to improve the information on DR. SUSAN LICATA DURHAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.