MEDICARE: DR. CHARLES PATRICK CARROLL MD

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	207W00000X	Ophthalmology Physician	35038423	OH
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	35038423	OH

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	:	1780681239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES PATRICK CARROLL MD

Provider Business Mailing Address
First Line	:	89 SYLVANIA DR
Second Line	:	2ND FL
City	:	DAYTON
State	:	OH
Zip	:	45440-3237
Country	:	US
Telephone Number	:	937-427-8900
Fax Number	:	937-427-1710

Provider Business Practice Location Address
First Line	:	89 SYLVANIA DR
Second Line	:	2ND FL
City	:	DAYTON
State	:	OH
Zip	:	45440-3237
Country	:	US
Telephone Number	:	937-427-8900
Fax Number	:	937-427-1710

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/10/2017

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