Provider Demographics
NPI:1801845581
Name:COURTNEY, CARLA S (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:S
Last Name:COURTNEY
Suffix:
Gender:F
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-0037
Mailing Address - Country:US
Mailing Address - Phone:563-785-4497
Mailing Address - Fax:563-785-4607
Practice Address - Street 1:409 8TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747
Practice Address - Country:US
Practice Address - Phone:563-785-4497
Practice Address - Fax:563-785-4607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1286781Medicaid
U59492Medicare UPIN
IA1286781Medicaid
IA5648230001Medicare NSC