Provider Demographics
NPI:1689776858
Name:O'NEAL, CARLTON E (OD)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:E
Last Name:O'NEAL
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 1:1750 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4902
Mailing Address - Country:US
Mailing Address - Phone:903-438-2233
Mailing Address - Fax:903-438-2244
Practice Address - Street 1:1750 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4902
Practice Address - Country:US
Practice Address - Phone:903-438-2233
Practice Address - Fax:903-438-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3079T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E15HMedicare UPIN