JOHN E THORDSEN JR. (NPI# 1073659769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073659769 |
| Entity Type | Individual |
| Full Name | JOHN E THORDSEN JR. |
| Credential | MD |
| Practice Address |
4414 Lake Boone Trl Ste 302 Raleigh NC 27607-7514 |
| Mailing Address |
4414 Lake Boone Trl 302 Raleigh NC 27607-7513 |
| Practice Telephone | 1978280389 |
| Practice Fax Number | 9197828189 |
| Mailing Telephone | 9197828038 |
| Mailing Fax Number | 9197828189 |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 2011-00308 | NC | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
2011-00308 | NC | Allopathic & Osteopathic Physicians |
| Street Address |
4414 LAKE BOONE TRL STE 302 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27607-7514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770561722 | Eugene A. Milder | Ophthalmology | 4414 Lake Boone Trl Ste 302, Raleigh, NC 27607-7514 | 2006-01-09 |
| 1891105227 | Shaina Marie Rubino Loverde | Internal Medicine | 4414 Lake Boone Trl Ste 302, Raleigh, NC 27607-7514 | 2014-05-07 |
| 1205256724 | Ronald Walden Milam Jr. | Ophthalmology | 4414 Lake Boone Trl Ste 302, Raleigh, NC 27607-7514 | 2014-04-23 |
| 1205193208 | Laura Lynn Snyder | Ophthalmology | 4414 Lake Boone Trl Ste 302, Raleigh, NC 27607 | 2012-04-13 |
| 1376715565 | Daniel Kittelle Bennett | Ophthalmology | 4414 Lake Boone Trl Ste 302, Raleigh, NC 27607-7514 | 2008-03-27 |
| 1457435992 | Rebecca Anna Manning | Ophthalmology | 4414 Lake Boone Trl Ste 302, Raleigh, NC 27607-7514 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972093144 | Kyndra Lawson | Behavior Technician | 5121 Kingdom Way, Suite 100, Raleigh, NC 27607 | 2018-05-14 |
| 1578082905 | Margaret Roberts Bova | Dietitian, Registered | 4207 Lake Boone Trail, Suite 210, Raleigh, NC 27607 | 2017-09-18 |
| 1184141897 | Chricat Garrard | Nurse Practitioner | 4207 Lake Boone Trl Ste 200, Raleigh, NC 27607 | 2017-08-23 |
| 1487178620 | John Patrick Morton | Pharmacist | 2411 Landmark Dr, Raleigh, NC 27607 | 2017-07-31 |
| 1023538857 | Heather Margaret Mazzola | Audiologist | 7800 Lake Boone Trail, 100, Raleigh, NC 27607 | 2017-06-22 |
| 1790216984 | North Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2411 Landmark Drive, Raleigh, NC 27607 | 2017-03-21 |
| 1558819516 | Corilin Nocito Meggitt | Nurse Practitioner | 4505 Fair Meadows Ln Ste 102, Raleigh, NC 27607 | 2016-09-19 |
| 1942757034 | Stacie Walker | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 311, Raleigh, NC 27607 | 2016-09-06 |
| 1831644533 | Alisa Smajlagic Howe | Nurse Practitioner | 4210 Lake Boone Trail, Rex Rehab & Nursing Center, Raleigh, NC 27607 | 2016-08-23 |
| 1235598632 | Yoseph Saleh | Dentist | 107 Minden Ln, Raleigh, NC 27607 | 2016-02-15 |
| Find all providers in zip 27607 | ||||
| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154526192 | Jeremy Shaw | Ophthalmology | Duke Eye Center Dumc 3802, Durham, NC 27710-0001 | 2007-06-19 |
| 1922457464 | Oleg Alekseev | Ophthalmology | 2351 Erwin Rd, Durham, NC 27705-4699 | 2016-06-06 |
| 1689048423 | Central Triad Retina, Pa | Ophthalmology | 3333 Brookview Hills Blvd, Suite 107, Winston Salem, NC 27103-5661 | 2015-11-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.