Provider Demographics
NPI:1285796748
Name:POWERS, CARL F (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:F
Last Name:POWERS
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 1:614 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2724
Mailing Address - Country:US
Mailing Address - Phone:231-347-3298
Mailing Address - Fax:231-347-0564
Practice Address - Street 1:614 HOWARD ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2724
Practice Address - Country:US
Practice Address - Phone:231-347-3298
Practice Address - Fax:231-347-0564
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN80540001Medicare ID - Type Unspecified
MIU25868Medicare UPIN