MEDICARE: DR. LARRY WAYNE CARR O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WP0200X	Pediatric Optometrist	WV723OD	WV
2	152WC0802X	Corneal and Contact Management Optometrist	WV723OD	WV
3	152WS0006X	Sports Vision Optometrist	WV723OD	WV
4	152WX0102X	Occupational Vision Optometrist	WV723OD	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508869298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY WAYNE CARR O.D.

Provider Business Mailing Address
First Line	:	416 S BRADFIELD DR
Second Line	:
City	:	SAINT MARYS
State	:	WV
Zip	:	26170-9771
Country	:	US
Telephone Number	:	304-684-9594
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 WASHINGTON ST
Second Line	:
City	:	SAINT MARYS
State	:	WV
Zip	:	26170-1041
Country	:	US
Telephone Number	:	304-684-2491
Fax Number	:	304-684-2492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	10/16/2007

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