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Individual

DR. JOHN D CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
2170 HIGHWAY 51 S STE 6, HERNANDO, MS 38632-1108
(662) 449-1384
(662) 449-1385
Mailing address
2170 HIGHWAY 51 S STE 6, HERNANDO, MS 38632-1108
(662) 449-1384
(662) 449-1385

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
671
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00880114
MS
01
4053594
BCBS OF TN
TN
01
7068456
AETNA PIN
MS
01
P00697422
RETIRED RAILROAD MEDICARE PTAN
MS
Enumeration date
10/13/2006
Last updated
11/11/2014
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