Provider Demographics
NPI:1518949205
Name:CARTER, LARRY D (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:CARTER
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:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-1807
Mailing Address - Country:US
Mailing Address - Phone:205-921-7426
Mailing Address - Fax:205-921-7589
Practice Address - Street 1:1925 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-6611
Practice Address - Country:US
Practice Address - Phone:205-921-7426
Practice Address - Fax:205-921-7589
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS353TA002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL580002701OtherRAILROAD MEDICARE
AL000059414Medicaid
AL59414OtherBCBS OF ALABAMA
AL3887770001Medicare NSC
1982888426Medicare NSC
AL580002701OtherRAILROAD MEDICARE
AL000059414Medicare ID - Type Unspecified
AL580002701Medicare PIN