Provider Demographics
NPI:1952410839
Name:CARTER, ROBERT S (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:CARTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 PENTZ RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5542
Mailing Address - Country:US
Mailing Address - Phone:530-877-6583
Mailing Address - Fax:530-877-6590
Practice Address - Street 1:6009 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5542
Practice Address - Country:US
Practice Address - Phone:530-877-6583
Practice Address - Fax:530-877-6590
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10481Medicare UPIN