Provider Demographics
NPI:1053373043
Name:CARLTON, GEORGE R JR (DISPENSING OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:CARLTON
Suffix:JR
Gender:M
Credentials:DISPENSING OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 SOUTH DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2951
Mailing Address - Country:US
Mailing Address - Phone:256-249-9339
Mailing Address - Fax:256-249-9339
Practice Address - Street 1:20 SOUTH DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2951
Practice Address - Country:US
Practice Address - Phone:256-249-9339
Practice Address - Fax:256-249-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51004040OtherBLUE CROSS BLUE SHIELD
AL0656980001Medicare UPIN