Provider Demographics
NPI:1407916372
Name:CARSON, EDMOND J (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:J
Last Name:CARSON
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:DR
Other - First Name:RAMA
Other - Middle Name:R
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:4310 BUFFALO GAP RD STE 1450
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2762
Mailing Address - Country:US
Mailing Address - Phone:325-692-1627
Mailing Address - Fax:325-690-9905
Practice Address - Street 1:4310 BUFFALO GAP RD STE 1450
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2762
Practice Address - Country:US
Practice Address - Phone:325-692-1627
Practice Address - Fax:325-690-9905
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6542T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist