=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306110077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRY R CARNEY OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2012
-----------------------------------------------------
Last Update Date | 04/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2144 SW 36TH ST
-----------------------------------------------------
City | TOPEKA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66611-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-266-1100
-----------------------------------------------------
Fax | 785-266-2441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2144 SW 36TH ST
-----------------------------------------------------
City | TOPEKA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66611-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-266-1100
-----------------------------------------------------
Fax | 785-266-2441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF OPTOMETRY
-----------------------------------------------------
Name | DR. TERRY RAY CARNEY
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 785-266-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1255-3
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------