Provider Demographics
NPI:1194221648
Name:PETRASH, CARSON COPE (MD)
Entity type:Individual
Prefix:DR
First Name:CARSON
Middle Name:COPE
Last Name:PETRASH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:800-833-5921
Mailing Address - Fax:713-513-5613
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:800-833-5921
Practice Address - Fax:713-513-5613
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU4600207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36379873OtherTEXAS DRIVERS LICENSE