Basic Information
| Provider Information | |||||||||
| NPI: | 1407891476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSON | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 WASHINGTON ST. | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185875900 | ||||||||
| FaxNumber: | 5185875938 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 WASHINGTON ST. | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185875900 | ||||||||
| FaxNumber: | 5185875938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 01/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TUV 004102 | NY | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 00719824 | 05 | NY | MEDICAID |