Provider Demographics
NPI:1881687671
Name:CARR, THOMAS J (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CARR
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 1:309 HAMILTON ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 HAMILTON ST
Practice Address - Street 2:UNIT A
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2181
Practice Address - Country:US
Practice Address - Phone:630-232-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU44190Medicare UPIN
ILK23333Medicare PIN