Provider Demographics
NPI:1295937803
Name:DRS FESSENDEN & CARR P A
Entity type:Organization
Organization Name:DRS FESSENDEN & CARR P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-758-4902
Mailing Address - Street 1:7313 52ND PL E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-8915
Mailing Address - Country:US
Mailing Address - Phone:941-758-4902
Mailing Address - Fax:941-739-9575
Practice Address - Street 1:7313 52ND PL E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-8915
Practice Address - Country:US
Practice Address - Phone:941-758-4902
Practice Address - Fax:941-739-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3541152W00000X
FLOPC2983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL491591Medicare UPIN
FL463271Medicare UPIN