MEDICARE: DR. WESTLEY DUANE CARR 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
1	152W00000X	Optometrist	1063-OD	WV
2	152W00000X	Optometrist	0618001873	VA

General Provider Information

NPI Number	:	1891926473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESTLEY DUANE CARR O.D.

Provider Business Mailing Address
First Line	:	201 GREASY RIDGE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-6900
Country	:	US
Telephone Number	:	304-487-1435
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 GREASY RIDGE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-6900
Country	:	US
Telephone Number	:	304-487-1435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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