Provider Demographics
NPI:1578648572
Name:FICK, CARRIE JO (OD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:FICK
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:RR 1 BOX 257
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26347-9734
Mailing Address - Country:US
Mailing Address - Phone:304-739-2698
Mailing Address - Fax:
Practice Address - Street 1:32 TYGART MALL RD
Practice Address - Street 2:INSIDE WALMART
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK202152W00000X
WV1008-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist