Provider Demographics
NPI:1013135128
Name:IRVINE, CARRIE TOBIN (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:TOBIN
Last Name:IRVINE
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 1:5491 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4936
Mailing Address - Country:US
Mailing Address - Phone:901-212-4262
Mailing Address - Fax:901-685-0782
Practice Address - Street 1:1714 W MASSEY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4205
Practice Address - Country:US
Practice Address - Phone:901-685-5520
Practice Address - Fax:901-685-0782
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist