Provider Demographics
NPI:1316959596
Name:CAROZZA, RAYMOND MARC (OD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MARC
Last Name:CAROZZA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2915 CYPRESS RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923
Mailing Address - Country:US
Mailing Address - Phone:870-246-5090
Mailing Address - Fax:870-246-7421
Practice Address - Street 1:2915 CYPRESS RD
Practice Address - Street 2:SUITE B
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4228
Practice Address - Country:US
Practice Address - Phone:870-246-5090
Practice Address - Fax:870-246-7421
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6888T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316959596OtherNPI
TX49978OtherAR BCBS
TX81613QOtherTX BCBS
TX6888TOtherSTATE LICENSE
TX49978OtherAR BCBS