Provider Demographics
NPI:1306803713
Name:CARNAGGIO, CARL JOSEPH I (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH
Last Name:CARNAGGIO
Suffix:I
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4703
Mailing Address - Country:US
Mailing Address - Phone:225-924-5460
Mailing Address - Fax:225-924-0988
Practice Address - Street 1:7515 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4703
Practice Address - Country:US
Practice Address - Phone:225-924-5460
Practice Address - Fax:225-924-0988
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131-131T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139475Medicaid
LA48808Medicare ID - Type Unspecified
LAVO8501Medicare UPIN