MEDICARE: CARRIE DIVIN 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	152W00000X	Optometrist	5927 TG	TX

General Provider Information

NPI Number	:	1770666521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE DIVIN O. D.

Provider Business Mailing Address
First Line	:	267 BOLTON CIR
Second Line	:
City	:	WEST
State	:	TX
Zip	:	76691-2400
Country	:	US
Telephone Number	:	254-867-1957
Fax Number	:	254-867-8445

Provider Business Practice Location Address
First Line	:	1521 NORTH INTERSTATE HIGHWAY 35
Second Line	:
City	:	BELLMEAD
State	:	TX
Zip	:	76705
Country	:	US
Telephone Number	:	254-867-1957
Fax Number	:	254-867-8445

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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Directions to “ CARRIE DIVIN O. D.” Practice Location

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