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1407916372 NPI number — EDMOND J CARSON OPTOMETRIST

NPI Number: 1407916372
Health Care Provider/Practitioner: EDMOND J CARSON OPTOMETRIST

Information about “1407916372” NPI (EDMOND J CARSON OPTOMETRIST) exists in 1407916372 in HTML format HTML  |  1407916372 in plain Text format TXT  |  1407916372 in PDF (Portable Document Format) PDF  |  1407916372 in an XML format XML  formats.

NPI Number : 1407916372 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407916372",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CARSON",
    "FirstName": "EDMOND",
    "MiddleName": "J",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OPTOMETRIST",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CARSON",
    "OtherFirstName": "RAMA",
    "OtherMiddleName": "R",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "OPTOMETRIST",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "4310 BUFFALO GAP RD STE 1450",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ABILENE",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "79606-2762",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "325-692-1627",
    "MailingAddressFaxNumber": "325-690-9905",
    "FirstLinePracticeLocationAddress": "4310 BUFFALO GAP RD STE 1450",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ABILENE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "79606-2762",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "325-692-1627",
    "PracticeLocationAddressFaxNumber": "325-690-9905",
    "EnumerationDate": "12/11/2006",
    "LastUpdateDate": "02/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "6542T",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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