Healthcare Provider Details

I. General information

NPI: 1477618833
Provider Name (Legal Business Name): JOANNA CARTER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JOANNA PLAVIN

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N PHOENIX RD STE 320
PHOENIX OR
97535-9107
US

IV. Provider business mailing address

205 N PHOENIX RD STE 320
PHOENIX OR
97535-9107
US

V. Phone/Fax

Practice location:
  • Phone: 541-664-5535
  • Fax:
Mailing address:
  • Phone: 541-779-2525
  • Fax: 541-779-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3135
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3135
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3135
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number3135
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: