Provider Demographics
NPI:1497708515
Name:CARELLI, MICHAEL F (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:CARELLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3304
Mailing Address - Country:US
Mailing Address - Phone:772-287-8777
Mailing Address - Fax:772-287-1996
Practice Address - Street 1:2090 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3304
Practice Address - Country:US
Practice Address - Phone:772-287-8777
Practice Address - Fax:772-287-1996
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078776101Medicaid
U17383Medicare UPIN
20261CMedicare ID - Type Unspecified