Provider Demographics
NPI:1508414582
Name:BROOKS, MEGHAN LUISA DALZIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:LUISA DALZIEL
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:LUISA
Other - Last Name:DALZIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1174 TURLINGTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451
Mailing Address - Country:US
Mailing Address - Phone:910-408-1116
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1174 TURLINGTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:910-408-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist