Provider Demographics
NPI:1710157912
Name:CARPENTER EYE ASSOCIATES OD, PLLC
Entity Type:Organization
Organization Name:CARPENTER EYE ASSOCIATES OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BLANE
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-542-0501
Mailing Address - Street 1:8429 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4704
Mailing Address - Country:US
Mailing Address - Phone:704-542-0501
Mailing Address - Fax:704-542-4733
Practice Address - Street 1:8429 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4704
Practice Address - Country:US
Practice Address - Phone:704-542-0501
Practice Address - Fax:704-542-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1179261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center