Basic Information
| Provider Information | |||||||||
| NPI: | 1548789951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J. CARSON WOOLWINE O.D. PLLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 S. MISSOURI AVE. | ||||||||
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| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33756 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 912 S. MISSOURI AVE. | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274436493 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2017 | ||||||||
| LastUpdateDate: | 09/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | WOOLWINE | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | CARSON | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 8132705929 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5248 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.