Provider Demographics
NPI:1306110077
Name:TERRY R CARNEY OD PA
Entity type:Organization
Organization Name:TERRY R CARNEY OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-266-1100
Mailing Address - Street 1:2144 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2554
Mailing Address - Country:US
Mailing Address - Phone:785-266-1100
Mailing Address - Fax:785-266-2441
Practice Address - Street 1:2144 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2554
Practice Address - Country:US
Practice Address - Phone:785-266-1100
Practice Address - Fax:785-266-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1255-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1306110077OtherPALMETTO GBA GROUP NPI
KSKA2517OtherMEDICARE PTAN
KS1669402475OtherINDIVIDUAL NPI
KSP01038533OtherPALMETTO GBA INDIVIDUAL PTAN
KS0669310001OtherNORIDIAN PTAN
KSDS5255OtherPALMETTO GBA GROUP PTAN
KS1306110077OtherPALMETTO GBA GROUP NPI
KS1669402475OtherINDIVIDUAL NPI