Healthcare Provider Details

I. General information

NPI: 1679575948
Provider Name (Legal Business Name): GARY G CAROTHERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 MONTGOMERY RD STE 120
CINCINNATI OH
45236-4284
US

IV. Provider business mailing address

PO BOX 631662
CINCINNATI OH
45263-1662
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5999
  • Fax: 513-791-4567
Mailing address:
  • Phone: 859-581-7120
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.028347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: