Healthcare Provider Details

I. General information

NPI: 1134046394
Provider Name (Legal Business Name): NATHAN JOHN CARLING OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MCANDREWS RD STE 100
MEDFORD OR
97504-6497
US

IV. Provider business mailing address

339 N SKIDMORE ST UNIT B
PORTLAND OR
97217-2985
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-1392
  • Fax:
Mailing address:
  • Phone: 865-851-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4838
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: