Provider Demographics
NPI:1689773137
Name:CARTER, HENRY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOSEPH
Last Name:CARTER
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 1:309 THIBODEAUX DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4444
Mailing Address - Country:US
Mailing Address - Phone:337-349-6414
Mailing Address - Fax:
Practice Address - Street 1:309 THIBODEAUX DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4444
Practice Address - Country:US
Practice Address - Phone:337-349-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1218-381T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B222Medicare ID - Type Unspecified
LAT98276Medicare UPIN