Provider Demographics
NPI:1376741181
Name:LOBOCCHIARO, CAROLYN RACCUGLIA (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:RACCUGLIA
Last Name:LOBOCCHIARO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PRINCETON OVAL
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5337
Mailing Address - Country:US
Mailing Address - Phone:732-308-0778
Mailing Address - Fax:
Practice Address - Street 1:1655 OAK TREE RD STE 265
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2856
Practice Address - Country:US
Practice Address - Phone:732-494-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00543400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093145Medicare ID - Type Unspecified
NJU66444Medicare UPIN