Provider Demographics
NPI:1225399397
Name:CAROLINA EYE CARE ON MERRIMON, O.D., P.A.
Entity Type:Organization
Organization Name:CAROLINA EYE CARE ON MERRIMON, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-236-0099
Mailing Address - Street 1:825B MERRIMON AVE.
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:828-236-0099
Mailing Address - Fax:828-236-1236
Practice Address - Street 1:825-B MERRIMON AVE.
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:828-236-0099
Practice Address - Fax:828-236-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802152Medicaid
NC2473154Medicare PIN