Provider Demographics
NPI:1609226794
Name:LUMBY, CARISSA (OD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:LUMBY
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 1:7700 CAT HOLLOW DR
Mailing Address - Street 2:STE 105
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5797
Mailing Address - Country:US
Mailing Address - Phone:512-501-2100
Mailing Address - Fax:
Practice Address - Street 1:7700 CAT HOLLOW DR STE 105
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5797
Practice Address - Country:US
Practice Address - Phone:512-501-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8916TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist