Provider Demographics
NPI:1700872983
Name:CARTER, DAVID ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:CARTER
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 1:1592 11TH ST
Mailing Address - Street 2:SUITE C2
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-2940
Mailing Address - Country:US
Mailing Address - Phone:559-638-6099
Mailing Address - Fax:559-638-4685
Practice Address - Street 1:1592 11TH ST
Practice Address - Street 2:SUITE C2
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654
Practice Address - Country:US
Practice Address - Phone:559-638-6099
Practice Address - Fax:559-638-4685
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2018-07-26
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAOPT8068-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770058782OtherVSP
CA770058782OtherOTHER INUSANCE COMPANIES
CA770058782OtherOTHER INUSANCE COMPANIES
CA0389270001Medicare NSC
CAT10642Medicare UPIN
CASD0080680Medicare ID - Type Unspecified