Provider Demographics
NPI:1417916974
Name:CARHOUN, CORRINNE S (OD)
Entity Type:Individual
Prefix:DR
First Name:CORRINNE
Middle Name:S
Last Name:CARHOUN
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 1:99 PARK AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514
Mailing Address - Country:US
Mailing Address - Phone:630-986-0280
Mailing Address - Fax:
Practice Address - Street 1:99 PARK AVE.
Practice Address - Street 2:STE. 202
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1267
Practice Address - Country:US
Practice Address - Phone:630-986-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006439152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0422240001OtherDMERC
IL0422240001OtherDEMRC M CARE
IL0422240001OtherDEMRC M CARE
ILMC0356370OtherDEA
IL241460Medicare PIN