Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | IL |
NPI | 1235210964 |
---|---|
Provider Name | Dr. Colby Lee Carter |
First Address | Chicago, IL 60657-1101 |
Second Address | North Riverside, IL 60546-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |