MEDICARE: DR. GEOFFREY PETER CARLSON 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	9216	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	410010871	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ52852Y	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518968213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY PETER CARLSON O.D.

Provider Business Mailing Address
First Line	:	2585 ORO DAM BLVD E
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6005
Country	:	US
Telephone Number	:	530-922-2020
Fax Number	:	530-895-1664

Provider Business Practice Location Address
First Line	:	2585 ORO DAM BLVD E
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6005
Country	:	US
Telephone Number	:	530-922-2020
Fax Number	:	530-922-2021

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/08/2021

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Directions to “ DR. GEOFFREY PETER CARLSON O.D.” Practice Location

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