Provider Demographics
NPI:1174627194
Name:CARR, STEPHEN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:CARR
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 1:531 FAIRFIELD BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6740
Mailing Address - Country:US
Mailing Address - Phone:203-255-6039
Mailing Address - Fax:
Practice Address - Street 1:6515 MAIN ST
Practice Address - Street 2:SUITE 8 L
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1354
Practice Address - Country:US
Practice Address - Phone:203-374-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT70108Medicare UPIN
CT410000753Medicare ID - Type UnspecifiedMEDICARE