Provider Demographics
NPI:1295140994
Name:EARLE, ADRIENNE PAK (OD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:PAK
Last Name:EARLE
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 1:3000 TRENT RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5735
Mailing Address - Country:US
Mailing Address - Phone:252-637-2921
Mailing Address - Fax:252-637-1863
Practice Address - Street 1:3000 TRENT RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-637-2921
Practice Address - Fax:252-637-1863
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH893152W00000X
NC2392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3098468Medicaid
NH1295140994Medicare PIN