Provider Demographics
NPI:1154680866
Name:EMBREY, MEAGAN JARRELL (OD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:JARRELL
Last Name:EMBREY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 COLONY RD
Mailing Address - Street 2:105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5017
Mailing Address - Country:US
Mailing Address - Phone:704-543-9000
Mailing Address - Fax:
Practice Address - Street 1:7615 COLONY RD
Practice Address - Street 2:105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5017
Practice Address - Country:US
Practice Address - Phone:704-543-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist