Provider Demographics
NPI:1063571966
Name:CARTER, FRED WILLIAM III (OD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:WILLIAM
Last Name:CARTER
Suffix:III
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 1:293 WILLOW STREET
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514
Mailing Address - Country:US
Mailing Address - Phone:760-872-7511
Mailing Address - Fax:760-872-2094
Practice Address - Street 1:293 WILLOW STREET
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514
Practice Address - Country:US
Practice Address - Phone:760-872-7511
Practice Address - Fax:760-872-2094
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5120T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0051200Medicare ID - Type Unspecified
T09875Medicare UPIN