Provider Demographics
NPI:1750475604
Name:HUNTINGTON, CARRIE ANN (OD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:HUNTINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:SCHLOTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2360 N BROADWAY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-6270
Mailing Address - Country:US
Mailing Address - Phone:812-528-7622
Mailing Address - Fax:
Practice Address - Street 1:1204 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240
Practice Address - Country:US
Practice Address - Phone:812-663-7015
Practice Address - Fax:812-663-7136
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003440B152W00000X
IN18003440152W00000X
IN18003440A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1750475604Medicaid