Provider Demographics
NPI:1194854703
Name:SOARES, CARLOS ALBERTO (RDO)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:SOARES
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1901
Mailing Address - Country:US
Mailing Address - Phone:508-674-6915
Mailing Address - Fax:508-614-3135
Practice Address - Street 1:1554 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1901
Practice Address - Country:US
Practice Address - Phone:508-674-6915
Practice Address - Fax:508-614-3135
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1531085OtherMASS HEALTH ID#
MA1531085OtherMASS HEALTH ID#
MA1009460001Medicare NSC