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General NPI Number Information
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NPI Number | 1063687820
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Entity Type | Organization
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Legal Business Name | CARLSON OPTOMETRY INC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 2200 5TH AVE
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City | OROVILLE
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State | CA
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Zip | 95965-5816
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Country | US
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Telephone | 530-533-1975
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Fax | 530-533-4466
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Provider Business Mailing Address
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Address Line | 2200 5TH AVE
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City | OROVILLE
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State | CA
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Zip | 95965-5816
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Country | US
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Telephone | 530-533-1975
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Fax | 530-533-4466
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEOFFREY PETER CARLSON
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Credential | O.D.
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Telephone | 530-533-1975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | CA9216
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License Number State | CA
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