Provider Demographics
NPI:1073703278
Name:CARPENTER, BRIAN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 SW WANAMAKER RD
Mailing Address - Street 2:SUITE 192
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4293
Mailing Address - Country:US
Mailing Address - Phone:785-272-0707
Mailing Address - Fax:785-271-1512
Practice Address - Street 1:1300 BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1821
Practice Address - Country:US
Practice Address - Phone:785-562-5111
Practice Address - Fax:785-562-1050
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651179OtherBLUE CROSS BLUE SHIELD OF KS
KS200569190AMedicaid
KS651179OtherBLUE CROSS BLUE SHIELD OF KS
KS5278900001Medicare NSC