Provider Demographics
NPI:1659303600
Name:CARRICO, DAVID OWEN (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:OWEN
Last Name:CARRICO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 KELLEY DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4500
Mailing Address - Country:US
Mailing Address - Phone:731-642-5003
Mailing Address - Fax:731-642-8756
Practice Address - Street 1:1024 KELLEY DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4500
Practice Address - Country:US
Practice Address - Phone:731-642-5003
Practice Address - Fax:731-642-8756
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35972301Medicaid
TNT85041OtherUPIN
TN35972301Medicaid