Organization
FUQUAY OPHTHALMOLOGY AND GLAUCOMA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH W ROACH MD (PRESIDENT)
(919) 567-3709
Entity
Organization
Contact information
Practice address
605 ATTAIN ST STE 101, FUQUAY VARINA, NC 27526-1972
(919) 567-3709
(919) 567-3710
Mailing address
605 ATTAIN ST STE 101, FUQUAY VARINA, NC 27526-1972
(919) 567-3709
(919) 567-3710
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89014WM
—
NC
Enumeration date
09/07/2006
Last updated
06/02/2020
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