Provider Demographics
NPI:1558367300
Name:CONDON, CARA A (OD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:A
Last Name:CONDON
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 1:580 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1543
Mailing Address - Country:US
Mailing Address - Phone:517-265-6055
Mailing Address - Fax:517-265-6115
Practice Address - Street 1:580 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1543
Practice Address - Country:US
Practice Address - Phone:517-265-6055
Practice Address - Fax:517-265-6115
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV05240Medicare UPIN