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NPI Code Detail

MEDICARE: DR. CARL D CORROW O.D.

MEDICARE: DR. CARL D CORROW O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristODTG00509RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689681066
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARL D CORROW O.D.
Provider Business Mailing Address
First Line : 780 NORTH MAIN ST.
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-5707
Country : US
Telephone Number : 401-331-2020
Fax Number : 401-331-1179
Provider Business Practice Location Address
First Line : 780 NORTH MAIN ST.
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-5707
Country : US
Telephone Number : 401-331-2020
Fax Number : 401-331-1179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 12/16/2009

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