1841837085 NPI number — CAROLINA VISION CARE DRS. MCINTOSH & ASSOCIATES OD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841837085 NPI number — CAROLINA VISION CARE DRS. MCINTOSH & ASSOCIATES OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA VISION CARE DRS. MCINTOSH & ASSOCIATES OD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841837085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 W ARLINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27834-5704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-752-4380
Provider Business Mailing Address Fax Number:
252-757-0419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 E FIRE TOWER RD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28590-9398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-752-4380
Provider Business Practice Location Address Fax Number:
252-757-0419
Provider Enumeration Date:
12/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MCINTOSH
Authorized Official First Name:
MELONIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CORPORATE OFFICER
Authorized Official Telephone Number:
252-752-4380

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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