Provider Demographics
NPI:1477615524
Name:IAFIGLIOLA, CARLA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:MARIE
Last Name:IAFIGLIOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:SORCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:146 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3665
Mailing Address - Country:US
Mailing Address - Phone:847-548-2770
Mailing Address - Fax:
Practice Address - Street 1:146 CENTER ST
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3665
Practice Address - Country:US
Practice Address - Phone:847-548-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8825444OtherMULTIPLAN
IL7235044OtherAETNA
IL1636706OtherBCBS
U67875Medicare UPIN
IL1636706OtherBCBS
IL7235044OtherAETNA