Provider Demographics
NPI:1891979480
Name:DOUGLAS B CARTER II MD PC
Entity Type:Organization
Organization Name:DOUGLAS B CARTER II MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:970-352-1877
Mailing Address - Street 1:1931 65TH AVE
Mailing Address - Street 2:#C
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7946
Mailing Address - Country:US
Mailing Address - Phone:970-352-1877
Mailing Address - Fax:970-356-9274
Practice Address - Street 1:1931 65TH AVE
Practice Address - Street 2:#C
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7946
Practice Address - Country:US
Practice Address - Phone:970-352-1877
Practice Address - Fax:970-356-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28078207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C446918Medicare PIN