Provider Demographics
NPI:1447278726
Name:CARPENTER, WILLARD CARLETON (OD/OPTOMETRIST)
Entity type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:CARLETON
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:OD/OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-0148
Mailing Address - Country:US
Mailing Address - Phone:603-863-7770
Mailing Address - Fax:603-863-7248
Practice Address - Street 1:57 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1519
Practice Address - Country:US
Practice Address - Phone:603-863-7770
Practice Address - Fax:603-863-7248
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1052OtherDAVIS VISION
NHNH0222OtherEYEMED
NH355970OtherCIGNA
NH43913OtherSPECTERA
NH0907770Y0NH01OtherBLUE CROSS/BLUE SHIELD
NH0907770Y0NH01OtherBCBS
NH4149509OtherMVP
NH80587770Medicaid
NH43913OtherSPECTERA
NH0951430001Medicare NSC
NH1052OtherDAVIS VISION