Provider Demographics
NPI:1407016033
Name:CARL C CARTER OD PA
Entity Type:Organization
Organization Name:CARL C CARTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-789-3335
Mailing Address - Street 1:3691 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7679
Mailing Address - Country:US
Mailing Address - Phone:561-789-3335
Mailing Address - Fax:561-736-8991
Practice Address - Street 1:3615 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7244
Practice Address - Country:US
Practice Address - Phone:561-734-1887
Practice Address - Fax:561-736-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084200100Medicaid
FLAW806Medicare PIN