Provider Demographics
NPI:1356446082
Name:DR LARRY W CARR PC
Entity Type:Organization
Organization Name:DR LARRY W CARR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-684-2491
Mailing Address - Street 1:214 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170
Mailing Address - Country:US
Mailing Address - Phone:304-684-2491
Mailing Address - Fax:304-684-2492
Practice Address - Street 1:214 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170
Practice Address - Country:US
Practice Address - Phone:304-684-2491
Practice Address - Fax:304-684-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV7230D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009188Medicaid
1508869298OtherINDIVIDUAL NPI NUMBER
T32589Medicare UPIN
WV9192153Medicare PIN
WV0316400001Medicare NSC