=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356446082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR LARRY W CARR PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 09/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 WASHINGTON STREET
-----------------------------------------------------
City | ST MARYS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-684-2491
-----------------------------------------------------
Fax | 304-684-2492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 WASHINGTON STREET
-----------------------------------------------------
City | ST MARYS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-684-2491
-----------------------------------------------------
Fax | 304-684-2492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LARRY WAYNE CARR
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 304-684-2491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | WV7230D
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------