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General NPI Number Information
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NPI Number | 1396994323
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Entity Type | Organization
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Legal Business Name | JERRY B. CARTER, O.D.
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 2419 NOWATA PL SUITE 103
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City | BARTLESVILLE
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State | OK
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Zip | 74006-4708
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Country | US
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Telephone | 918-333-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 NOWATA PL SUITE 103
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City | BARTLESVILLE
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State | OK
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Zip | 74006-4708
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Country | US
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Telephone | 918-333-9292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRY B CARTER
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Credential | O.D.
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Telephone | 918-333-9292
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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 | 1079
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License Number State | OK
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