Provider Demographics
NPI:1265484620
Name:PALMER, CARRIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:PALMER
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 1:1018 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4949
Mailing Address - Country:US
Mailing Address - Phone:801-392-5100
Mailing Address - Fax:801-392-5100
Practice Address - Street 1:1018 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4949
Practice Address - Country:US
Practice Address - Phone:801-392-5100
Practice Address - Fax:801-392-5100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4786262-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT410985054121Medicaid
UTU84118Medicare UPIN
UT8154160159Medicare ID - Type UnspecifiedMEDICARE PROVIDER #