Provider Demographics
NPI:1942268727
Name:CARTER, PAMELA BLANCHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BLANCHARD
Last Name:CARTER
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 1:309 THIBODEAUX DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4444
Mailing Address - Country:US
Mailing Address - Phone:504-258-4989
Mailing Address - Fax:
Practice Address - Street 1:1538 US HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535
Practice Address - Country:US
Practice Address - Phone:337-457-5840
Practice Address - Fax:337-457-6795
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1068-376T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1684961Medicaid
LA1684961Medicaid
LA4B006Medicare ID - Type Unspecified