=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518135755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CCCARTER,OD AND ASSOCIATES,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2008
-----------------------------------------------------
Last Update Date | 02/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2537 ARLINGTON CRES
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-960-5331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2537 ARLINGTON CRES
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-960-5331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER C CARTER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 205-960-5331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | S675TA160
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------