Provider Demographics
NPI:1427034420
Name:DR THOMAS A MEBANE OD
Entity Type:Organization
Organization Name:DR THOMAS A MEBANE OD
Other - Org Name:THOMAS A MEBANE OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MEBANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-537-3401
Mailing Address - Street 1:444 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-537-3401
Mailing Address - Fax:252-537-8872
Practice Address - Street 1:444 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-3401
Practice Address - Fax:252-537-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09574OtherBCBS
NC7909574Medicaid
NCT65060Medicare UPIN
2468950AMedicare PIN
0849860001Medicare NSC
246535CMedicare PIN