MEDICARE: DR. JAMES W CARPENTER JR. 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	3118TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00E55L	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932119765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W CARPENTER JR. O.D.

Provider Business Mailing Address
First Line	:	2101 N MIDLAND DR STE 8
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5593
Country	:	US
Telephone Number	:	432-689-0901
Fax Number	:	432-689-0191

Provider Business Practice Location Address
First Line	:	2101 N MIDLAND DR STE 8
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5593
Country	:	US
Telephone Number	:	432-689-0901
Fax Number	:	432-689-0191

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/07/2011

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