Healthcare Provider Details

I. General information

NPI: 1285206052
Provider Name (Legal Business Name): CARLEY WARD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 WAKE FOREST RD
CLARKSVILLE MD
21029-1500
US

IV. Provider business mailing address

12345 WAKE FOREST RD # RX
CLARKSVILLE MD
21029-1500
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-7507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2802
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: