Healthcare Provider Details

I. General information

NPI: 1669382776
Provider Name (Legal Business Name): KEVIN CHRISTIAN CARTER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RIVER PL
LANSING IL
60438-6028
US

IV. Provider business mailing address

2 RIVER PL
LANSING IL
60438-6028
US

V. Phone/Fax

Practice location:
  • Phone: 708-474-7404
  • Fax:
Mailing address:
  • Phone: 708-474-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012161
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: