Provider Demographics
NPI:1811065378
Name:CARLSON, RAYMOND EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EUGENE
Last Name:CARLSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3750 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5306
Mailing Address - Country:US
Mailing Address - Phone:559-227-2529
Mailing Address - Fax:559-227-2344
Practice Address - Street 1:3750 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5306
Practice Address - Country:US
Practice Address - Phone:559-227-2529
Practice Address - Fax:559-227-2344
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9893T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0098931Medicaid
CASD0098930Medicare PIN
CASD0098931Medicaid