Provider Demographics
NPI:1245365212
Name:CARR-LUCE, KERRI (OD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CARR-LUCE
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 1:950 E PECOS RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2401
Mailing Address - Country:US
Mailing Address - Phone:480-331-6360
Mailing Address - Fax:480-546-4491
Practice Address - Street 1:950 E PECOS RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2401
Practice Address - Country:US
Practice Address - Phone:480-331-6360
Practice Address - Fax:480-546-4491
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88263Medicare UPIN