Provider Demographics
NPI:1164573473
Name:POULTNEY, CAREY BETH (OD)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:BETH
Last Name:POULTNEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 DALY RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-1936
Mailing Address - Country:US
Mailing Address - Phone:805-794-9862
Mailing Address - Fax:
Practice Address - Street 1:3301 E MAIN ST
Practice Address - Street 2:PACIFIC VIEW MALL STE. 1006
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5076
Practice Address - Country:US
Practice Address - Phone:805-650-3196
Practice Address - Fax:805-650-1682
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11946T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91943Medicare UPIN
CASD0119460Medicare ID - Type Unspecified