Provider Demographics
NPI:1104054964
Name:DANTINI, MEGAN LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEIGH
Last Name:DANTINI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NW MAYNARD RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8706
Mailing Address - Country:US
Mailing Address - Phone:919-467-9834
Mailing Address - Fax:919-466-0045
Practice Address - Street 1:1100 NW MAYNARD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8706
Practice Address - Country:US
Practice Address - Phone:919-467-9834
Practice Address - Fax:919-466-0045
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003608152W00000X
NC2187152W00000X
VA0618001935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104054964Medicaid
NC5914698Medicaid
IN200945210Medicaid
VAVVC719D345Medicare PIN
NCNCH038C699Medicare PIN
VA1104054964Medicaid
NC5914698Medicaid
IN825700WWWWMedicare PIN