Provider Demographics
NPI:1437134848
Name:MEBANE, THOMAS ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLEN
Last Name:MEBANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-1910
Mailing Address - Country:US
Mailing Address - Phone:252-537-3401
Mailing Address - Fax:252-537-8872
Practice Address - Street 1:444 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-1910
Practice Address - Country:US
Practice Address - Phone:252-537-3401
Practice Address - Fax:252-537-8872
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909574Medicaid
0849860001OtherPALMETTO
NC09574OtherBCBS
2468950AMedicare ID - Type Unspecified
NC7909574Medicaid