Provider Demographics
NPI:1164688073
Name:CARRERO, VERONICA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MARIE
Last Name:CARRERO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:MARIE
Other - Last Name:HORMILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7300 CORPORATE CENTER DR STE 501
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1241
Mailing Address - Country:US
Mailing Address - Phone:305-418-2025
Mailing Address - Fax:
Practice Address - Street 1:3233 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5427
Practice Address - Country:US
Practice Address - Phone:305-826-0660
Practice Address - Fax:305-888-0156
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7310TG152W00000X
FLOPC 4579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005480800Medicaid