NPI 1023043163

Susan Licata Durham, OD

Practitioner Pediatric Optometrist Raleigh, NC

Practice location

Address: 10207 Cerny St Suite 100, Raleigh, NC 27617-7878
Phone: (919) 361-2299
Fax: (919) 361-0055

Registered specialties (5)

Pediatric Optometrist Primary

Eye and Vision Services Providers Taxonomy 152WP0200X Licence 1335 (NC)

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Corneal and Contact Management Optometrist

Eye and Vision Services Providers Taxonomy 152WC0802X Licence 1335 (NC)

Low Vision Rehabilitation Optometrist

Eye and Vision Services Providers Taxonomy 152WL0500X Licence 1335 (NC)

Sports Vision Optometrist

Eye and Vision Services Providers Taxonomy 152WS0006X Licence 1335 (NC)

Vision Therapy Optometrist

Eye and Vision Services Providers Taxonomy 152WV0400X Licence 1335 (NC)

Registry record

NPI: 1023043163
Entity type: Individual
Sex (as registered): Female
NPI issued: 11 Jul 2006
Record last updated: 29 Sep 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.