NPIMap

Organization Active NPI

Eric J. Oberdorf, O.D., P.a.

  • Optometrist
  • Raleigh, NC
National Provider Identifier
1396920955
Registry record updated Apr 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1645 Issued in NC
Legal business name
ERIC J. OBERDORF, O.D., P.A.
Practice address
7200 Creedmoor Rd.
Suite 100
Raleigh, NC 27613
Phone
(919) 847-9751
Fax
(919) 676-3918
NPI assigned
Jan 2, 2008
Last updated
Apr 23, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2009

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

Authorized official

Name
Eric Jon Oberdorf, ODNPI 1053390898
Title
Owner/President
Phone
(919) 847-9751

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1645 NC Primary

Addresses

Primary practice location

7200 Creedmoor Rd.
Suite 100
Raleigh, NC 27613

Mailing address

7200 Creedmoor Rd.
Suite 100
Raleigh, NC 27613
Phone (919) 847-9751

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421000243 NC Part B Supplier - Clinic/Group Practice 9335135946 Receives reassigned benefits from 3 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

7200 Creedmoor Rd
Ste 100
Raleigh, NC 27613
Phone (919) 847-9751

7208 Creedmoor Rd
#108
Raleigh, NC 27613
Phone (919) 847-9751

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240444800000",
    "number": "1396920955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 CREEDMOOR RD.",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27613",
            "telephone_number": "919-847-9751",
            "fax_number": "919-676-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 CREEDMOOR RD.",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27613",
            "telephone_number": "919-847-9751",
            "fax_number": "919-676-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC J. OBERDORF, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2009-04-23",
        "status": "A",
        "authorized_official_last_name": "OBERDORF",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "919-847-9751",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; 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.