Individual provider Active NPI

Eric R Fogleman, O.D.

  • Optometrist
  • Southern Pines, NC
National Provider Identifier
1144271222
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1331 Issued in NC
Practice address
2160 Midland Rd
Suite B
Southern Pines, NC 28387-2927
Phone
(910) 295-3220
Fax
(910) 295-0507
NPI assigned
May 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1331 NC Primary

Addresses

Primary practice location

2160 Midland Rd
Suite B
Southern Pines, NC 28387-2927

Mailing address

2160 Midland Rd
Suite B
Southern Pines, NC 28387-2927
Phone (910) 295-3220

Other identifiers 3

IdentifierTypeStateIssuer
890929EMedicaidNC
0292120001OtherNCDMERC
0929EOtherNCBCBS PROVIDER #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080117000671 NC Practitioner - Optometry 6305927187 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clark Optometric Center PAGroup PAC ID 6709911092, 45 clinicians

Practice addresses (Care Compare)

1776 Old Morganton Rd
Southern Pines, NC 28387-5185
Phone (910) 295-3220

2216 E NC Hwy 54
Durham, NC 27713-2208
Phone (919) 544-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1331NCMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Clark Optometric Center PA Optometrist CurrentSince May 1, 2017 Accepting new patients
Family Eyecare of Apex OD, PA Optometrist Past Accepting new patients

Locations

1103 Pine Plaza Dr
Apex, NC 27523
Phone (919) 367-8411

3460 Ten Ten Rd
Ste 112B
Cary, NC 27518
Phone (919) 367-5555

1398 Kildaire Farm Rd
Ste 100
Cary, NC 27511
Phone (919) 467-3238

2216 E NC Highway 54
Durham, NC 27713
Phone (919) 544-2020

2210 E NC Highway 54
Durham, NC 27713
Phone (919) 544-2020

200 Perimeter Park Dr
Ste D
Morrisville, NC 27560
Phone (910) 893-4141

598 Airport Blvd
Ste 700
Morrisville, NC 27560
Phone (910) 587-8412

7016 Harps Mill Rd
Raleigh, NC 27615
Phone (919) 676-5610

8111 Creedmoor Rd
Ste 138
Raleigh, NC 27613
Phone (919) 301-8866

1829 Doctors Dr
Sanford, NC 27330
Phone (919) 776-2032

2160 Midland Rd
#B
Southern Pines, NC 28387
Phone (910) 295-3220

1776 Old Morganton Rd
Southern Pines, NC 28387
Phone (910) 295-3220

2160B Midland Rd
Southern Pnes, NC 28387
Phone (910) 295-3220

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1144271222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 MIDLAND RD",
            "address_2": "SUITE B",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283872927",
            "telephone_number": "910-295-3220",
            "fax_number": "910-295-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 MIDLAND RD",
            "address_2": "SUITE B",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283872927",
            "telephone_number": "910-295-3220",
            "fax_number": "910-295-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGLEMAN",
        "first_name": "ERIC",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890929E",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0292120001",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "0929E",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southern Pines, NC

Sources for this page

Verify at the official NPI Registry.