Provider Demographics
NPI:1568742146
Name:CARR, DEANDRE MONIQUE (OD)
Entity Type:Individual
Prefix:MS
First Name:DEANDRE
Middle Name:MONIQUE
Last Name:CARR
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 1:131 HANDLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272
Mailing Address - Country:US
Mailing Address - Phone:601-346-7549
Mailing Address - Fax:601-346-7927
Practice Address - Street 1:131 HANDLEY BOULEVARD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272
Practice Address - Country:US
Practice Address - Phone:601-346-7549
Practice Address - Fax:601-346-7927
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist