Provider Demographics
NPI:1366549289
Name:WILLEY, CAREY PAGE (OD)
Entity type:Individual
Prefix:DR
First Name:CAREY
Middle Name:PAGE
Last Name:WILLEY
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 1:101 BAY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1104
Mailing Address - Country:US
Mailing Address - Phone:410-228-0415
Mailing Address - Fax:
Practice Address - Street 1:401 RACE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1835
Practice Address - Country:US
Practice Address - Phone:410-228-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1367-501T152W00000X
MDTA1807152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAV01011Medicare UPIN