Provider Demographics
NPI:1700803269
Name:CARR, RONALD J (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:CARR
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 1:14225 S 95TH AVE
Mailing Address - Street 2:STE 453
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2265
Mailing Address - Country:US
Mailing Address - Phone:708-361-6141
Mailing Address - Fax:708-361-5327
Practice Address - Street 1:14225 S 95TH AVE
Practice Address - Street 2:STE 453
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2265
Practice Address - Country:US
Practice Address - Phone:708-361-6141
Practice Address - Fax:708-361-5327
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046 008711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008711 1Medicaid
IL1621656OtherBCBS
U51103Medicare UPIN
ILL88409Medicare ID - Type Unspecified