Provider Demographics
NPI:1376161000
Name:STOCKER, CARLA (LDO)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:STOCKER
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 DAETWYLER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-3726
Mailing Address - Country:US
Mailing Address - Phone:321-297-4075
Mailing Address - Fax:
Practice Address - Street 1:7410 DAETWYLER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-3726
Practice Address - Country:US
Practice Address - Phone:321-297-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2680156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician