Provider Demographics
NPI:1760582308
Name:KEARNS, CARRIE MARIE MCDANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:MARIE MCDANIEL
Last Name:KEARNS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:MARIE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2316
Mailing Address - Country:US
Mailing Address - Phone:319-334-6087
Mailing Address - Fax:319-334-6488
Practice Address - Street 1:1310 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2316
Practice Address - Country:US
Practice Address - Phone:319-334-6087
Practice Address - Fax:319-334-6488
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009900152W00000X
IA002396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist