Provider Demographics
NPI:1891762894
Name:CARCAMO, ARISTIDES (OD)
Entity Type:Individual
Prefix:DR
First Name:ARISTIDES
Middle Name:
Last Name:CARCAMO
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 1:1000 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2406
Mailing Address - Country:US
Mailing Address - Phone:415-826-2020
Mailing Address - Fax:650-556-1802
Practice Address - Street 1:1000 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3144
Practice Address - Country:US
Practice Address - Phone:415-826-2020
Practice Address - Fax:650-556-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8144T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891762894Medicaid
CABG153AOtherMEDICARE PTAN
CABG153AMedicare PIN
CA0446570002Medicare NSC
CAT10653Medicare UPIN