Provider Demographics
NPI:1467666982
Name:CARROLL, JAMES J (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:CARROLL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHEECHUNK RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6801
Mailing Address - Country:US
Mailing Address - Phone:845-294-0761
Mailing Address - Fax:
Practice Address - Street 1:111 INDEPENDENT WAY
Practice Address - Street 2:SUITE B
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2369
Practice Address - Country:US
Practice Address - Phone:845-278-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005647-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV005647-1Medicare UPIN