Provider Demographics
NPI:1003887274
Name:LATHAM, MEGAN H (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:H
Last Name:LATHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:HAROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:5100 HWY 70 WEST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4512
Practice Address - Country:US
Practice Address - Phone:252-727-5290
Practice Address - Fax:252-727-0091
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0922UOtherBLUE CROSS BLUE SHIELD
NC89093P8Medicaid
NC0922UOtherBLUE CROSS BLUE SHIELD
NCU72217Medicare UPIN