Provider Demographics
NPI:1497984231
Name:DR J. RICHARD CARVER, PA
Entity Type:Organization
Organization Name:DR J. RICHARD CARVER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:479-394-2020
Mailing Address - Street 1:601 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-3227
Mailing Address - Country:US
Mailing Address - Phone:479-394-2020
Mailing Address - Fax:479-394-2137
Practice Address - Street 1:601 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-3227
Practice Address - Country:US
Practice Address - Phone:479-394-2020
Practice Address - Fax:479-394-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103818722Medicaid
AR47664OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
AR47664OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)