Provider Demographics
NPI:1538616743
Name:CARNEGLIA, RAYMOND THOMAS III (OD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:THOMAS
Last Name:CARNEGLIA
Suffix:III
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 1:10401 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5712
Mailing Address - Country:US
Mailing Address - Phone:512-345-2000
Mailing Address - Fax:
Practice Address - Street 1:10401 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5712
Practice Address - Country:US
Practice Address - Phone:512-345-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9110T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9110TOtherTEXAS OPTOMETRY BOARD