Healthcare Provider Details

I. General information

NPI: 1841837085
Provider Name (Legal Business Name): CAROLINA VISION CARE DRS. MCINTOSH & ASSOCIATES OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E FIRE TOWER RD STE 108
WINTERVILLE NC
28590-9398
US

IV. Provider business mailing address

1804 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-4380
  • Fax: 252-757-0419
Mailing address:
  • Phone: 252-752-4380
  • Fax: 252-757-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MELONIE R MCINTOSH
Title or Position: CORPORATE OFFICER
Credential:
Phone: 252-752-4380