Provider Demographics
NPI:1275726887
Name:ENDERLE, CAREY L (OD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:L
Last Name:ENDERLE
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0130
Mailing Address - Country:US
Mailing Address - Phone:701-662-4085
Mailing Address - Fax:701-662-6685
Practice Address - Street 1:404 HWY 2 EAST
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-0130
Practice Address - Country:US
Practice Address - Phone:701-662-4085
Practice Address - Fax:701-662-6685
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND893075OtherND VISION SERVICES
ND28944OtherBS OF NORTH DAKOTA
ND450433379000OtherWORKERS SAFETY AND COMP
ND0311120001OtherDME MEDICARE
ND60446Medicaid
ND893075OtherND VISION SERVICES