Provider Demographics
NPI:1689681066
Name:CORROW, CARL D (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:CORROW
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 1:780 NORTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5707
Mailing Address - Country:US
Mailing Address - Phone:401-331-2020
Mailing Address - Fax:401-331-1179
Practice Address - Street 1:780 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5707
Practice Address - Country:US
Practice Address - Phone:401-331-2020
Practice Address - Fax:401-331-1179
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057197Medicaid
RI7057197Medicaid
RIU99725Medicare UPIN