Healthcare Provider Details

I. General information

NPI: 1225371271
Provider Name (Legal Business Name): MEGAN ELISABETH CARTER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN ELISABETH DELKAS OD

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 9TH ST
MARINA CA
93933
US

IV. Provider business mailing address

18579 MCCLELLAN CIRCLE
EAST GARRISON CA
93933
US

V. Phone/Fax

Practice location:
  • Phone: 831-884-1000
  • Fax:
Mailing address:
  • Phone: 530-906-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number14706
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: