Provider Demographics
NPI:1407891476
Name:CARSON, ERIC ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:CARSON
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 1:235 WASHINGTON ST.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5963
Mailing Address - Country:US
Mailing Address - Phone:518-587-5900
Mailing Address - Fax:518-587-5938
Practice Address - Street 1:235 WASHINGTON ST.
Practice Address - Street 2:SUITE #1
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5963
Practice Address - Country:US
Practice Address - Phone:518-587-5900
Practice Address - Fax:518-587-5938
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 004102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00719824Medicaid
NY14-1657317OtherTIN
39674CMedicare PIN
NYT26624Medicare UPIN