Provider Demographics
NPI:1821323585
Name:MENET, CARRIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:MENET
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 1:1321 N GALENA AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1009
Mailing Address - Country:US
Mailing Address - Phone:815-284-1600
Mailing Address - Fax:
Practice Address - Street 1:1321 N GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1009
Practice Address - Country:US
Practice Address - Phone:815-284-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010305152W00000X
OK2626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist