Provider Demographics
NPI:1164530754
Name:CARPENTER, DAVID SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:CARPENTER
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 1:310 LOCUST ST.
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740
Mailing Address - Country:US
Mailing Address - Phone:304-589-6930
Mailing Address - Fax:
Practice Address - Street 1:310 LOCUST ST
Practice Address - Street 2:SUITE #6
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-487-2020
Practice Address - Fax:304-431-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1001-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV410046671OtherRAILROAD MEDICARE
WV999995836OtherVSP
WV3101007000Medicaid
WV999995836OtherVSP
WV410046671OtherRAILROAD MEDICARE