Provider Demographics
NPI:1124057468
Name:CARTER, JOHN M
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2437
Mailing Address - Country:US
Mailing Address - Phone:315-635-3904
Mailing Address - Fax:315-635-5525
Practice Address - Street 1:52 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2437
Practice Address - Country:US
Practice Address - Phone:315-635-3904
Practice Address - Fax:315-635-5525
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003234156FX1800X
NY14000006712237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01608084Medicaid
NY01636433Medicaid