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General NPI Number Information
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NPI Number | 1578648572
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Entity Type | Individual
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Provider Name | CARRIE JO FICK O.D
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 32 TYGART MALL RD INSIDE WALMART
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-366-3425
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Fax |
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Provider Business Mailing Address
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Address Line | RR 1 BOX 257
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City | FLEMINGTON
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State | WV
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Zip | 26347-9734
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Country | US
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Telephone | 304-739-2698
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Fax |
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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 | 202
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1008-OD
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License Number State | WV
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