Healthcare Provider Details

I. General information

NPI: 1104826841
Provider Name (Legal Business Name): PAULINE T MERRILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 GROVE RD
GREENVILLE SC
29605-4620
US

IV. Provider business mailing address

1126 GROVE RD
GREENVILLE SC
29605-4620
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-5722
  • Fax: 864-233-6027
Mailing address:
  • Phone: 864-233-5722
  • Fax: 864-233-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9500667
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number90924
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036096119
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036096119
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: