Healthcare Provider Details

I. General information

NPI: 1932108321
Provider Name (Legal Business Name): DR. ROBERT G CARDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12289 HOLMAN CHURCH RD
GORDO AL
35466-9433
US

IV. Provider business mailing address

PO BOX 116
ELROD AL
35458-0116
US

V. Phone/Fax

Practice location:
  • Phone: 205-339-7761
  • Fax:
Mailing address:
  • Phone: 205-339-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS426TA020
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: