Healthcare Provider Details

I. General information

NPI: 1841399227
Provider Name (Legal Business Name): CARRIE ELIZABETH WOLFE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ELIZABETH GAUTREAU OD

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 TIN VALLEY CIR STE A
BIRMINGHAM AL
35235-3248
US

IV. Provider business mailing address

1825 TIN VALLEY CIR STEA
BIRMINGHAM AL
35235-3248
US

V. Phone/Fax

Practice location:
  • Phone: 205-661-2020
  • Fax: 205-661-2010
Mailing address:
  • Phone: 205-661-2020
  • Fax: 205-661-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR154TA706
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: