Provider Demographics
NPI:1003322397
Name:CARMONA EYE CARE PLLC
Entity Type:Organization
Organization Name:CARMONA EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-249-0234
Mailing Address - Street 1:11360 PELLICANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5904
Mailing Address - Country:US
Mailing Address - Phone:915-775-2020
Mailing Address - Fax:915-590-6224
Practice Address - Street 1:11360 PELLICANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5904
Practice Address - Country:US
Practice Address - Phone:915-775-2020
Practice Address - Fax:915-590-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty