Provider Demographics
NPI:1780672113
Name:CARLIN, FRED H (OD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:H
Last Name:CARLIN
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 1:428 WINDMERE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7668
Mailing Address - Country:US
Mailing Address - Phone:814-234-2015
Mailing Address - Fax:814-238-5300
Practice Address - Street 1:428 WINDMERE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7668
Practice Address - Country:US
Practice Address - Phone:814-234-2015
Practice Address - Fax:814-238-5300
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
096231Medicare ID - Type Unspecified
T28505Medicare UPIN