Provider Demographics
NPI:1013065051
Name:CARRERA, GARY (ABOC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:CARRERA
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PAT BOOKER RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-4427
Mailing Address - Country:US
Mailing Address - Phone:210-658-3820
Mailing Address - Fax:210-658-4841
Practice Address - Street 1:207 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4427
Practice Address - Country:US
Practice Address - Phone:210-658-3820
Practice Address - Fax:210-658-4841
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR3174 DR3175156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFC63634OtherSAFEGUARD VISION
TX110510OtherEYEMED VISION CARE
TX514575OtherBCBS OF TEXAS
TXCO47384OtherSPECTERA VISION
TX44349OtherAVESIS VISION PLAN
TXFC63634OtherSAFEGUARD VISION