Provider Demographics
NPI:1497285241
Name:CAROLINA VISION OPTOMETRISTS PLLC
Entity Type:Organization
Organization Name:CAROLINA VISION OPTOMETRISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:QUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-414-5095
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-0399
Mailing Address - Country:US
Mailing Address - Phone:828-665-1577
Mailing Address - Fax:828-667-5061
Practice Address - Street 1:1431 SMOKEY PARK HIGHWAY
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715
Practice Address - Country:US
Practice Address - Phone:828-665-1577
Practice Address - Fax:828-667-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2465152W00000X
NC2466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty