=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386876837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRIE MM KEARNS, OD/PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2009
-----------------------------------------------------
Last Update Date | 11/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1310 1ST ST W
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50644-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-334-6087
-----------------------------------------------------
Fax | 319-334-6488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 737
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50644-0737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-334-6087
-----------------------------------------------------
Fax | 319-334-6488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. CARRIE MM KEARNS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 319-334-6087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 002396
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------