Provider Demographics
NPI:1043974231
Name:CARPENTER FAMILY VISION
Entity Type:Organization
Organization Name:CARPENTER FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-563-0850
Mailing Address - Street 1:205
Mailing Address - Street 2:MAIN ST.
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246
Mailing Address - Country:US
Mailing Address - Phone:517-563-0850
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:MI
Practice Address - Zip Code:49246-9573
Practice Address - Country:US
Practice Address - Phone:517-563-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty