DR. SIDNEY LOY GULLEDGE III (NPI# 1578533931) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578533931 |
| Entity Type | Individual |
| Full Name | DR. SIDNEY LOY GULLEDGE III |
| Credential | MD |
| Practice Address |
4301 Lake Boone Trl Ste 200 Raleigh NC 27607-7507 |
| Practice Telephone | 9197825210 |
| Mailing Telephone | 9197825210 |
| Mailing Fax Number | 9197843384 |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 20908 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8937876 | 05 |
| Street Address |
4301 LAKE BOONE TRL STE 200 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27607-7507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528061348 | Keith P Mankin | Orthopaedic Surgery | 4301 Lake Boone Trl, Ste 205, Raleigh, NC 27607-7507 | 2005-05-24 |
| 1518389550 | Mary J. Forbes, Md, Pllc | Internal Medicine | 4301 Lake Boone Trl, Ste 208, Raleigh, NC 27607-7507 | 2014-01-10 |
| 1841621281 | Raleigh Durham Medical Group, Pa | Orthopaedic Surgery | 4301 Lake Boone Trl, Suite 205, Raleigh, NC 27607-7507 | 2013-12-11 |
| 1871876441 | Associated Urologists of North Carolina Pa | Urology | 4301 Lake Boone Trl, Suite 300, Raleigh, NC 27607-7507 | 2011-09-21 |
| 1255599619 | Zarzar Psychiatric Associates Pllc | Psychiatry & Neurology | 4301 Lake Boone Trl, Suite 210, Raleigh, NC 27607-7507 | 2008-06-01 |
| 1558568626 | Piedmont Cardiology Pa | Internal Medicine | 4301 Lake Boone Trl, Suite 309, Raleigh, NC 27607-7507 | 2007-06-30 |
| 1669694154 | Whiteside and Daniel, P.a. | Psychologist | 4301 Lake Boone Trl, Suite 208, Raleigh, NC 27607-7507 | 2007-05-03 |
| 1275692667 | Wake Urological Associates, P.a. | Urology | 4301 Lake Boone Trl, Suite 300, Raleigh, NC 27607-7507 | 2006-12-08 |
| 1003822511 | Richard D Kane | Urology | 4301 Lake Boone Trl, Suite 300, Raleigh, NC 27607-7507 | 2006-08-01 |
| 1164445961 | David Paul Zarzar | Psychiatry & Neurology | 4301 Lake Boone Trl, Ste 210, Raleigh, NC 27607-7507 | 2006-07-25 |
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| 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 |
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| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104235001 | Capital Eye Center | Ophthalmology | 720 West Jones St, Raleigh, NC 27612 | 2014-08-05 |
| 1568882389 | James Constans | Ophthalmology | 2709 Blue Ridge Rd Ste 100, Raleigh, NC 27607-6462 | 2014-04-19 |
| 1215236419 | Pradeep Mettu | Ophthalmology | 4201 Lake Boone Trl Ste 103, Raleigh, NC 27607 | 2011-03-28 |
| 1427360783 | Lindsay Elise Adam | Ophthalmology | 2709 Blue Ridge Road, Suite 100, Raleigh, NC 27607-6462 | 2010-07-02 |
| 1487985248 | New Century Ophthalmology Group, Pllc | Ophthalmology | 5720 Creedmoor Rd Ste 101, Raleigh, NC 27612-2382 | 2010-01-19 |
| 1457499089 | Franklin Li | Ophthalmology | 2406 Blue Ridge Rd Ste 280, Raleigh, NC 27607-6680 | 2007-02-03 |
| 1770632564 | Koury Eye Clinic, LLC | Ophthalmology | 8305 Wycombe Ln, Raleigh, NC 27615-3036 | 2007-01-09 |
| 1225195142 | North Raleigh Ophthalmology, P.a. | Ophthalmology | 1422 East Millbrook Road, Raleigh, NC 27609-5179 | 2007-01-02 |
| 1568536563 | Mccormick Ophthalmology Pa | Ophthalmology | 8015 Creedmoor Rd, Suite 201, Raleigh, NC 27613-4397 | 2006-11-20 |
| 1972698439 | Albert Rogers Munn IIi | Ophthalmology | Capital Eye Center, 720 W Jones St, Raleigh, NC 27603-1427 | 2006-10-03 |
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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.