Provider Demographics
NPI:1336153741
Name:BUCHANAN, CAROL A (OD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 BRENTWOOD BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1300
Mailing Address - Country:US
Mailing Address - Phone:925-634-0303
Mailing Address - Fax:925-634-0338
Practice Address - Street 1:8440 BRENTWOOD BLVD STE F
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1300
Practice Address - Country:US
Practice Address - Phone:925-634-0303
Practice Address - Fax:925-634-0338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT 8323 TPLMedicare UPIN
CASD0083230Medicare UPIN
CA0315290001Medicare NSC