Healthcare Provider Details

I. General information

NPI: 1700872983
Provider Name (Legal Business Name): DAVID ALAN CARTER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

1592 11TH ST SUITE C2
REEDLEY CA
93654
US

IV. Provider business mailing address

1592 11TH ST SUITE C2
REEDLEY CA
93654-2940
US

V. Phone/Fax

Practice location:
  • Phone: 559-638-6099
  • Fax: 559-638-4685
Mailing address:
  • Phone: 559-638-6099
  • Fax: 559-638-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8068-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: