Provider Demographics
NPI:1508063520
Name:LEBOWITZ, CARRIE DANIELS (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:DANIELS
Last Name:LEBOWITZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:DANIELS
Other - Last Name:ENGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:459 N WILLETT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5121
Mailing Address - Country:US
Mailing Address - Phone:901-726-0065
Mailing Address - Fax:
Practice Address - Street 1:1245 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2211
Practice Address - Country:US
Practice Address - Phone:901-722-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist