Provider Demographics
NPI:1396820007
Name:CARPENTER, JAMES DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2505 ANTHEM VILLAGE DR # E-594
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-642-7711
Mailing Address - Fax:702-642-8822
Practice Address - Street 1:3210 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-642-7711
Practice Address - Fax:702-642-8822
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002132Medicaid
NVV38544Medicare PIN