Provider Demographics
NPI:1265485254
Name:CARTERET OPTOMETRY
Entity Type:Organization
Organization Name:CARTERET OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-247-4661
Mailing Address - Street 1:P.O. BOX 2009
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2506
Mailing Address - Country:US
Mailing Address - Phone:252-247-4661
Mailing Address - Fax:252-247-3776
Practice Address - Street 1:5053-A EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-247-4661
Practice Address - Fax:252-247-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890140YMedicaid
NC890140YMedicaid