Provider Demographics
NPI:1548361876
Name:CARTER, BARRY C (OD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:C
Last Name:CARTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:313 W COUNTRY CLUB RD
Mailing Address - Street 2:STE 11
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5804
Mailing Address - Country:US
Mailing Address - Phone:575-623-2020
Mailing Address - Fax:505-623-4875
Practice Address - Street 1:313 W COUNTRY CLUB RD
Practice Address - Street 2:STE 11
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5804
Practice Address - Country:US
Practice Address - Phone:505-623-2020
Practice Address - Fax:505-623-4875
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850388570OtherEIN
NMT75021Medicare UPIN
NM0207350001Medicare NSC