Provider Demographics
NPI:1053365536
Name:DEXTER FAMILY EYE CENTER PC
Entity type:Organization
Organization Name:DEXTER FAMILY EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DAVINA
Authorized Official - Last Name:CARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-424-0097
Mailing Address - Street 1:3045 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1126
Mailing Address - Country:US
Mailing Address - Phone:734-424-0097
Mailing Address - Fax:734-424-0097
Practice Address - Street 1:3045 BAKER RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1126
Practice Address - Country:US
Practice Address - Phone:734-424-0097
Practice Address - Fax:734-424-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003966152W00000X
MI4901003917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty