MEDICARE: DR. CHAD L. CARTER 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	T03319	MO
2	152W00000X	Optometrist	1776	TN

General Provider Information

NPI Number	:	1255323648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD L. CARTER O.D.

Provider Business Mailing Address
First Line	:	1531 E BRADFORD PKWY
Second Line	:	SUITE 100
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-6566
Country	:	US
Telephone Number	:	417-887-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 E BRADFORD PKWY
Second Line	:	SUITE 100
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-6566
Country	:	US
Telephone Number	:	417-887-3900
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/14/2012

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