Provider Demographics
NPI:1154426492
Name:CARTER, JANICE E (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2531
Mailing Address - Country:US
Mailing Address - Phone:715-394-7339
Mailing Address - Fax:715-392-7077
Practice Address - Street 1:1505 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2531
Practice Address - Country:US
Practice Address - Phone:715-394-7339
Practice Address - Fax:715-392-7077
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124880001Medicare ID - Type UnspecifiedNON ASSIGNED