Provider Demographics
NPI:1194877910
Name:CARTER, CARL C (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:C
Last Name:CARTER
Suffix:
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 1:3691 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7679
Mailing Address - Country:US
Mailing Address - Phone:561-789-3335
Mailing Address - Fax:
Practice Address - Street 1:3615 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7244
Practice Address - Country:US
Practice Address - Phone:561-734-1887
Practice Address - Fax:561-736-8991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP00000879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084200100Medicaid
FL19551YMedicare PIN