Provider Demographics
NPI:1720114499
Name:CARVER, DONNA G (OD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:G
Last Name:CARVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 N ROCK RUN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-3153
Practice Address - Country:US
Practice Address - Phone:815-744-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03574OtherSPECTERA
IL346484638OtherVSP
IL115683OtherEYE MED
IL3120OtherDAVIS VISION
IL346484638OtherVSP