Provider Demographics
NPI:1841399227
Name:WOLFE, CARRIE ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:WOLFE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:GAUTREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1825 TIN VALLEY CIR STEA
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3248
Mailing Address - Country:US
Mailing Address - Phone:205-661-2020
Mailing Address - Fax:205-661-2010
Practice Address - Street 1:1825 TIN VALLEY CIR STE A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3248
Practice Address - Country:US
Practice Address - Phone:205-661-2020
Practice Address - Fax:205-661-2010
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR154TA706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1154456077OtherGROUP NPI
AL009936439Medicaid
AL1074080006Medicare NSC
AL000032369Medicare PIN
V01261Medicare UPIN
AL009936439Medicaid