Healthcare Provider Details

I. General information

NPI: 1750353140
Provider Name (Legal Business Name): JOHN BOCOCK CARTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD SUTE 320
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD SUTE 320
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-3500
  • Fax: 540-722-3536
Mailing address:
  • Phone: 540-722-3500
  • Fax: 540-722-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101045744
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: