MEDICARE: CHAD A CARLSSON OD

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	2242	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11555337	OTHER		CAQH

General Provider Information

NPI Number	:	1508853904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD A CARLSSON OD

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-8575
Country	:	US
Telephone Number	:	864-359-1308
Fax Number	:	239-496-3939

Provider Business Practice Location Address
First Line	:	710 HOPEWELL DR STE 106
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-7108
Country	:	US
Telephone Number	:	843-543-6333
Fax Number	:	843-543-6332

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	05/26/2026

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Directions to “ CHAD A CARLSSON OD” Practice Location

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