Provider Demographics
NPI:1780670802
Name:CARL, BRIAN W (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:CARL
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 1:2791 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-9540
Mailing Address - Country:US
Mailing Address - Phone:717-741-4788
Mailing Address - Fax:717-747-0123
Practice Address - Street 1:2791 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9540
Practice Address - Country:US
Practice Address - Phone:717-741-4788
Practice Address - Fax:717-747-9111
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02146501OtherBLUE CROSS
PA828704OtherBLUE SHIELD
PA0165770001OtherDMERC REGION D
PAU59682Medicare UPIN
PA0165770001OtherDMERC REGION D