Provider Demographics
NPI:1396177085
Name:INTIHAR, ERIC L (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:INTIHAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GATEWAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5540
Mailing Address - Country:US
Mailing Address - Phone:704-663-7226
Mailing Address - Fax:704-662-3875
Practice Address - Street 1:132 GATEWAY BLVD STE C
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5540
Practice Address - Country:US
Practice Address - Phone:704-663-7226
Practice Address - Fax:704-662-3875
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002804152W00000X
SC1757152W00000X
390250X390200000X
NC2336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program