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General NPI Number Information
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NPI Number | 1225208317
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Entity Type | Organization
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Legal Business Name | JENNIFER CARTER
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 2625 N HWY 27 WALMART VISION CENTER
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City | LAFAYETTE
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State | GA
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Zip | 30728
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Country | US
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Telephone | 706-639-4909
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Fax |
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Provider Business Mailing Address
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Address Line | 44 AMBERWOOD DR
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City | RINGGOLD
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State | GA
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Zip | 30736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JENNIFER CARTER
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Credential | OD
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Telephone | 770-363-8045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | GA002081
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License Number State | GA
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