Provider Demographics
NPI:1396866323
Name:CARR EYE PROFESSIONALS PC
Entity Type:Organization
Organization Name:CARR EYE PROFESSIONALS PC
Other - Org Name:MIDWEST EYE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-361-6141
Mailing Address - Street 1:9661 W 143RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2088
Mailing Address - Country:US
Mailing Address - Phone:708-361-6141
Mailing Address - Fax:708-361-5327
Practice Address - Street 1:9661 W 143RD ST STE 202
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2088
Practice Address - Country:US
Practice Address - Phone:708-361-6141
Practice Address - Fax:708-361-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-007090152W00000X
152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL987920Medicare PIN
IL423370Medicare PIN