Individual
DR. SUSAN LICATA DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
10207 CERNY ST, SUITE 100, RALEIGH, NC 27617-7878
(919) 361-2299
(919) 361-0055
Mailing address
10207 CERNY ST, SUITE 100, RALEIGH, NC 27617-7878
(919) 361-2299
(919) 361-0055
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
1335
NC
152WL0500X
Low Vision Rehabilitation Optometrist
1335
NC
152WP0200X
Pediatric Optometrist
Primary
1335
NC
152WS0006X
Sports Vision Optometrist
1335
NC
152WV0400X
Vision Therapy Optometrist
1335
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223620002
PALMETTO DMERC
NC
01
—
410036278
RAILROAD MEDICARE
NC
Enumeration date
07/11/2006
Last updated
09/29/2011
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