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Individual

MRS. STACY U CARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O. D.

Contact information

Practice address
805 COMMERCE DR SW, SUITE A, CONYERS, GA 30094-6606
(770) 483-4831
(770) 483-4840
Mailing address
805 COMMERCE DR SW, SUITE A, CONYERS, GA 30094-6606
(770) 483-4831
(770) 483-4840

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1622
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
410036767
RAILROAD MEDICARE
01
52718823001
BLUECROSS BLUESHIELD
GA
01
5801653
AETNA
GA
Enumeration date
05/31/2006
Last updated
11/22/2011
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