NPIMap

Organization Active NPI

Tei-Wake Forest OD PLLC

  • Optometrist
  • Wake Forest, NC
National Provider Identifier
1134725609
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TEI-WAKE FOREST OD PLLC
Practice address
3211 Rogers Rd Ste 100
Wake Forest, NC 27587-3891
Phone
(919) 453-1220
Fax
(919) 453-1221
NPI assigned
Dec 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maria Guevara
Title
Billing Manager
Phone
(919) 648-2750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3211 Rogers Rd Ste 100
Wake Forest, NC 27587-3891

Mailing address

742 McKnight Dr Ste 100
Knightdale, NC 27545-7764
Phone (919) 266-2048

Other names 1

  • Heritage Eye Care, OD Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210121001677 NC Part B Supplier - Clinic/Group Practice 7719391390 Receives reassigned benefits from 5 practitioners
Practice locations: Wake Forest, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1134725609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 MCKNIGHT DR STE 100",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457764",
            "telephone_number": "919-266-2048",
            "fax_number": "919-266-4648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3211 ROGERS RD STE 100",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873891",
            "telephone_number": "919-453-1220",
            "fax_number": "919-453-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEI-WAKE FOREST OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "GUEVARA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "919-648-2750"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Eye Care, OD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.