MEDICARE: RUBEN ERIC CARLSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC4262	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881658565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN ERIC CARLSON OD

Provider Business Mailing Address
First Line	:	PO BOX 207151
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7151
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	5201 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5403
Country	:	US
Telephone Number	:	813-979-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	12/15/2020

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