Provider Demographics
NPI:1295860807
Name:MARK P CARUSO, OD, PA
Entity Type:Organization
Organization Name:MARK P CARUSO, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-630-3070
Mailing Address - Street 1:633 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2462
Mailing Address - Country:US
Mailing Address - Phone:954-630-3070
Mailing Address - Fax:
Practice Address - Street 1:7730 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-4301
Practice Address - Country:US
Practice Address - Phone:954-578-1746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty