Provider Demographics
NPI:1831260033
Name:LOGAN, CAROL ARMSTRONG (OD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ARMSTRONG
Last Name:LOGAN
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 1:560 RINEHART RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4897
Mailing Address - Country:US
Mailing Address - Phone:407-333-7333
Mailing Address - Fax:407-333-7313
Practice Address - Street 1:560 RINEHART RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4897
Practice Address - Country:US
Practice Address - Phone:407-333-7333
Practice Address - Fax:407-333-7313
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410045139OtherMEDICARE RR
FL410045139OtherMEDICARE RR
FL20134Medicare PIN