Provider Demographics
NPI:1396078390
Name:CANTERBURY, MEREDITH PARKER (OD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:PARKER
Last Name:CANTERBURY
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 1:6104 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6283
Mailing Address - Country:US
Mailing Address - Phone:919-572-0050
Mailing Address - Fax:919-572-9200
Practice Address - Street 1:6104 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6283
Practice Address - Country:US
Practice Address - Phone:919-572-0050
Practice Address - Fax:919-572-9200
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1560AOtherBCBS
NC5914140Medicaid
NC140140OtherBCBS NC
NC2484626Medicare PIN
NC7557DMedicare UPIN
NC7557LMedicare PIN
NC7557FMedicare PIN
NC7557JMedicare PIN
NC7557EMedicare PIN
1560AOtherBCBS
NC7557IMedicare PIN
NC7557GMedicare PIN
NC140140OtherBCBS NC
NC5914140Medicaid
NC7557BMedicare PIN