Provider Demographics
NPI:1407801129
Name:TODD, ELIZABETH DRYSDALE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DRYSDALE
Last Name:TODD
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:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-1025
Mailing Address - Country:US
Mailing Address - Phone:828-693-6924
Mailing Address - Fax:828-693-6986
Practice Address - Street 1:706 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3526
Practice Address - Country:US
Practice Address - Phone:828-693-6924
Practice Address - Fax:828-693-6986
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909894Medicaid
NC09894OtherBCBS
NC8909894Medicaid
NC246477Medicare PIN