Provider Demographics
NPI:1326227414
Name:ALICIA CARROLL MD OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY CENTER
Entity Type:Organization
Organization Name:ALICIA CARROLL MD OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-267-2660
Mailing Address - Street 1:2660 TATE BLVD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1465
Mailing Address - Country:US
Mailing Address - Phone:828-267-2660
Mailing Address - Fax:828-267-2661
Practice Address - Street 1:2660 TATE BLVD SE
Practice Address - Street 2:SUITE 200
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1465
Practice Address - Country:US
Practice Address - Phone:828-267-2660
Practice Address - Fax:828-267-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2349691Medicare PIN