Provider Demographics
NPI:1538132311
Name:CARPENTER, CHRISTOPHER C (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:CARPENTER
Suffix:
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 1:21309 E EXCELSIOR AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-5566
Mailing Address - Country:US
Mailing Address - Phone:480-540-4056
Mailing Address - Fax:480-782-1689
Practice Address - Street 1:916 W CHANDLER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2514
Practice Address - Country:US
Practice Address - Phone:480-963-7172
Practice Address - Fax:480-782-1689
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539570Medicaid
AZ539570Medicaid
AZU82683Medicare UPIN