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General NPI Number Information
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NPI Number | 1417956210
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Entity Type | Individual
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Provider Name | MARTIN WAYNE CARPENTER O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 709 MORGANTOWN AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-4331
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Country | US
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Telephone | 304-366-4721
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Fax | 304-366-4847
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Provider Business Mailing Address
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Address Line | 709 MORGANTOWN AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-4331
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Country | US
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Telephone | 304-366-4721
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Fax | 304-366-4847
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1013-00
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License Number State | WV
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