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General NPI Number Information
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NPI Number | 1326227414
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Entity Type | Organization
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Legal Business Name | ALICIA CARROLL MD OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY CENTER
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 2660 TATE BLVD SE SUITE 200
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City | HICKORY
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State | NC
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Zip | 28602-1465
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Country | US
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Telephone | 828-267-2660
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Fax | 828-267-2661
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Provider Business Mailing Address
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Address Line | 2660 TATE BLVD SE SUITE 200
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City | HICKORY
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State | NC
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Zip | 28602-1465
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Country | US
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Telephone | 828-267-2660
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Fax | 828-267-2661
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. ALICIA MARIE CARROLL
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Credential |
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Telephone | 828-267-2660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 200101318
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License Number State | NC
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