MEDICARE: DR. MARK GERARD CAROLAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	03767TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073516241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GERARD CAROLAN O.D.

Provider Business Mailing Address
First Line	:	5430 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3539
Country	:	US
Telephone Number	:	210-340-1212
Fax Number	:	210-340-1505

Provider Business Practice Location Address
First Line	:	5430 FREDERICKSBURG RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3539
Country	:	US
Telephone Number	:	210-340-1212
Fax Number	:	210-525-9617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/21/2025

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