Provider Demographics
NPI:1720471477
Name:EBERSOLE, CAROL (LDO)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EBERSOLE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4547
Mailing Address - Country:US
Mailing Address - Phone:330-666-0191
Mailing Address - Fax:330-668-9086
Practice Address - Street 1:3893 MEDINA RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4547
Practice Address - Country:US
Practice Address - Phone:330-666-0191
Practice Address - Fax:330-668-9086
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3404-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician