Provider Demographics
NPI:1588235931
Name:CARPENTER, ALYSSA COLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:COLE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2155 WHITE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4900
Practice Address - Country:US
Practice Address - Phone:717-848-4654
Practice Address - Fax:717-848-2118
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA123456152W00000X
PAOEG003827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist