Provider Demographics
NPI:1992367106
Name:BROOKS, ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:GRACE
Other - Last Name:CAPPELLARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:
Practice Address - Street 1:7016 HARPS MILL RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3243
Practice Address - Country:US
Practice Address - Phone:919-847-6889
Practice Address - Fax:919-847-2441
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2600152W00000X
FLOPC5643152W00000X
GAOPT003240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist