Provider Demographics
NPI:1841837085
Name:CAROLINA VISION CARE DRS. MCINTOSH & ASSOCIATES OD PA
Entity type:Organization
Organization Name:CAROLINA VISION CARE DRS. MCINTOSH & ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELONIE
Authorized Official - Middle Name:R
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 1:915 E FIRE TOWER RD STE 108
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9398
Practice Address - Country:US
Practice Address - Phone:252-752-4380
Practice Address - Fax:252-757-0419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA VISION CARE DR. THOMAS C. MCINTOSH OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty