Provider Demographics
NPI:1033509781
Name:CAROL ANN EBERT-GORB, O.D.
Entity Type:Organization
Organization Name:CAROL ANN EBERT-GORB, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EBERT-GORB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-668-3693
Mailing Address - Street 1:4924 ARDEN FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2958
Mailing Address - Country:US
Mailing Address - Phone:850-668-3693
Mailing Address - Fax:850-668-3693
Practice Address - Street 1:1500 APALACHEE PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3055
Practice Address - Country:US
Practice Address - Phone:850-656-8980
Practice Address - Fax:580-656-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty