Healthcare Provider Details

I. General information

NPI: 1053393058
Provider Name (Legal Business Name): JAMES D CARRELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD CREDENTIAL'S OFFICE, KACH
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

900 WASHINGTON RD CREDENTIAL'S OFFICE, KACH
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-2021
  • Fax:
Mailing address:
  • Phone: 845-938-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05853TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: