Provider Demographics
NPI:1518968213
Name:CARLSON, GEOFFREY PETER (OD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:PETER
Last Name:CARLSON
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 1:2585 ORO DAM BLVD E
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6005
Mailing Address - Country:US
Mailing Address - Phone:530-922-2020
Mailing Address - Fax:530-895-1664
Practice Address - Street 1:2585 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6005
Practice Address - Country:US
Practice Address - Phone:530-922-2020
Practice Address - Fax:530-922-2021
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9216152W00000X
COOPT 9216 TPA152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ52852YOtherBLUE SHIELD
CA1518968213Medicaid
CA410010871OtherRAILROAD MEDICARE
CA1518968213Medicaid
CA6197880001Medicare NSC
CA410010871OtherRAILROAD MEDICARE