Provider Demographics
NPI:1649447178
Name:CARR &FESSENDEN OD, PA
Entity type:Organization
Organization Name:CARR &FESSENDEN OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR'S/OWNERS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-758-3264
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:941-758-3264
Mailing Address - Fax:
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:941-758-3264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARLE VISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE 970332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier