Provider Demographics
NPI:1295795607
Name:AYCOTH, CAROL LEATHER (OD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEATHER
Last Name:AYCOTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1030 HURLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7016
Mailing Address - Country:US
Mailing Address - Phone:704-636-4359
Mailing Address - Fax:704-638-2356
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:SALISBURY VAMC
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:704-638-3868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist