Provider Demographics
NPI:1679675581
Name:CAROLINA VISION CARE DR. THOMAS C. MCINTOSH OD PA
Entity Type:Organization
Organization Name:CAROLINA VISION CARE DR. THOMAS C. MCINTOSH OD PA
Other - Org Name:CAROLINA VISON CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-4380
Mailing Address - Street 1:1804 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-752-4380
Mailing Address - Fax:252-757-0419
Practice Address - Street 1:1804 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-752-4380
Practice Address - Fax:252-757-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1195152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011H7Medicaid
NC410017944OtherMEDICARE RAILROAD
NC011H7OtherBCBS GROUP
NC410017944OtherMEDICARE RAILROAD
NC89011H7Medicaid
NC2467759BMedicare PIN