Provider Demographics
NPI:1861519266
Name:CARPENTER OPTOMETRY PA
Entity type:Organization
Organization Name:CARPENTER OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-272-5544
Mailing Address - Street 1:5501 SW 29TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2479
Mailing Address - Country:US
Mailing Address - Phone:785-272-5544
Mailing Address - Fax:785-272-0275
Practice Address - Street 1:5501 SW 29TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2479
Practice Address - Country:US
Practice Address - Phone:785-272-5544
Practice Address - Fax:785-272-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1256-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1114920949OtherNPI
KS1114920949OtherNPI
KS650562Medicare PIN