Provider Demographics
NPI:1437347499
Name:CARVAJAL, ISABEL MADOLYN (OD)
Entity Type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:MADOLYN
Last Name:CARVAJAL
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 1:5140 STAGECOACH DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5140 STAGECOACH DR
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2242
Practice Address - Country:US
Practice Address - Phone:954-438-2428
Practice Address - Fax:954-438-2429
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC4213OtherFLORIDA LICENSE NUMBER