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General NPI Number Information
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NPI Number | 1073814737
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Entity Type | Organization
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Legal Business Name | CARTER VISION CARE, PLLC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 1157 E PUFFIN ST
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City | MERIDIAN
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State | ID
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Zip | 83642-7444
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Country | US
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Telephone | 208-880-6891
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Fax |
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Provider Business Mailing Address
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Address Line | 1157 E PUFFIN ST
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City | MERIDIAN
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State | ID
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Zip | 83642-7444
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Country | US
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Telephone | 208-880-6891
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SUSAN MOYER
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Credential |
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Telephone | 208-713-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100084
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License Number State | ID
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