Provider Demographics
NPI:1821061565
Name:BLACK-CARPENTER, DEBORAH A (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:BLACK-CARPENTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:518 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5353
Mailing Address - Country:US
Mailing Address - Phone:704-847-9833
Mailing Address - Fax:
Practice Address - Street 1:518 W JOHN ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5353
Practice Address - Country:US
Practice Address - Phone:704-847-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4360804OtherAETNA
NC8909106Medicaid
NC8909106Medicaid