Provider Demographics
NPI:1336107747
Name:CARPENTER, MATTHEW BLANE (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BLANE
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 1:8429 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4704
Mailing Address - Country:US
Mailing Address - Phone:704-542-0501
Mailing Address - Fax:704-542-4733
Practice Address - Street 1:8429 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4704
Practice Address - Country:US
Practice Address - Phone:704-542-0501
Practice Address - Fax:704-542-4733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09133OtherBCBS
NC4390933OtherAETNA
NC09133OtherBCBS
NCT65036Medicare UPIN