Provider Demographics
NPI:1144345398
Name:CARMAN, E EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:EDWARD
Last Name:CARMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 RIDENOUR BLVD NW
Mailing Address - Street 2:SUITE #201
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4463
Mailing Address - Country:US
Mailing Address - Phone:770-499-2020
Mailing Address - Fax:
Practice Address - Street 1:1615 RIDENOUR BLVD NW
Practice Address - Street 2:SUITE #201
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4463
Practice Address - Country:US
Practice Address - Phone:770-499-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581787113OtherTAX ID FOR EYEMED
GA581787113OtherTAX ID FOR COMPBENEFITS
GA581787113OtherTAX ID FOR VSP