Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4790TPA | CA |
NPI | 1003884776 |
---|---|
Provider Name | Marilyn A Carter |
First Address | Chula Vista, CA 91911 |
Second Address | El Cajon, CA 92020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 03/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0P4790 | (05) | CA |
T69950 | (02) |