Provider Demographics
NPI:1134395346
Name:CARRERA OPTICAL INC.
Entity type:Organization
Organization Name:CARRERA OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:210-658-3820
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR3174332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX44349OtherAVESIS VISION INSURANCE
TX514575OtherBLUE CROSS/BLUE SHIELD OF TEXAS
TXCO47384OtherSPECTERA VISION INSURANCE
TX110510OtherEYEMED VISION INSURANCE
TX63634OtherSAFEGUARD VISION INSURANCE
TX5965800001Medicare NSC