Provider Demographics
NPI:1215166152
Name:EVANS, MEGAN MORRIS (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MORRIS
Last Name:EVANS
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 1:22097 MEDICAL VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2904
Mailing Address - Country:US
Mailing Address - Phone:256-232-8240
Mailing Address - Fax:256-232-9427
Practice Address - Street 1:22097 MEDICAL VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613
Practice Address - Country:US
Practice Address - Phone:256-232-8240
Practice Address - Fax:256-232-9427
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSC22TA819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I412463OtherMEDICARE PTAN
AL113397Medicaid