Provider Demographics
NPI:1003972399
Name:CARROCK, JOSEPH A (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:CARROCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-6203
Mailing Address - Country:US
Mailing Address - Phone:315-797-2020
Mailing Address - Fax:315-736-2472
Practice Address - Street 1:4660 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-6203
Practice Address - Country:US
Practice Address - Phone:315-797-2020
Practice Address - Fax:315-736-2472
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist