Provider Demographics
NPI:1972570299
Name:KERR, CAROLYN J (OD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:KERR
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 1:8807 RIDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7344
Mailing Address - Country:US
Mailing Address - Phone:512-346-2959
Mailing Address - Fax:
Practice Address - Street 1:2013 WELLS BRANCH PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6900
Practice Address - Country:US
Practice Address - Phone:512-251-4040
Practice Address - Fax:512-252-1562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3189T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU13987Medicare UPIN
TX81278EMedicare ID - Type Unspecified