Provider Demographics
NPI:1265504898
Name:EASTER, CAROLYN LOUISE (OD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:EASTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27380 NOVI RD
Mailing Address - Street 2:TWELVE OAKS MALL
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3414
Mailing Address - Country:US
Mailing Address - Phone:248-646-9328
Mailing Address - Fax:248-344-1915
Practice Address - Street 1:27380 NOVI RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3414
Practice Address - Country:US
Practice Address - Phone:248-344-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU23852Medicare UPIN
MIN26930007Medicare ID - Type Unspecified