Basic Information
| Provider Information | |||||||||
| NPI: | 1124408638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EBEL | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5802 E VIRGINIA BEACH BLVD | ||||||||
| Address2: | STE 107 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235022475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572172050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5802 E VIRGINIA BEACH BLVD | ||||||||
| Address2: | STE 107 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235022475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572172050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2015 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618002400 | VA | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 0618002400 | VA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WL0500X | 0618002400 | VA | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WP0200X | 0618002400 | VA | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WS0006X | 0618002400 | VA | N | Eye and Vision Services Providers | Optometrist | Sports Vision | 152WV0400X | 0618002400 | VA | N | Eye and Vision Services Providers | Optometrist | Vision Therapy | 152WX0102X | 0618002400 | VA | N | Eye and Vision Services Providers | Optometrist | Occupational Vision |
No ID Information.