Provider Demographics
NPI:1184718116
Name:EVANS, CAROL S (OD)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:S
Last Name:EVANS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4006 LAYANG LAYANG CIR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4165
Mailing Address - Country:US
Mailing Address - Phone:760-720-3734
Mailing Address - Fax:760-729-3295
Practice Address - Street 1:4006 LAYANG LAYANG CIR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4165
Practice Address - Country:US
Practice Address - Phone:760-720-3734
Practice Address - Fax:760-729-3295
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist