Individual
DR. MARCIA R DETTLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
160 NE MAYNARD RD, SUITE 110, CARY, NC 27513
(919) 439-7995
(919) 415-0422
Mailing address
160 NE MAYNARD RD, SUITE 110, CARY, NC 27513
(919) 439-7995
(919) 415-0422
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1183
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093TF
BCBS NC PROVIDER NUMBER
NC
Enumeration date
08/15/2005
Last updated
09/20/2013
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