Provider Demographics
NPI:1649409319
Name:ISABEL M CARVAJAL OD PA
Entity Type:Organization
Organization Name:ISABEL M CARVAJAL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-873-4130
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:954-438-2428
Mailing Address - Fax:954-438-2429
Practice Address - Street 1:11605 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4109
Practice Address - Country:US
Practice Address - Phone:954-438-2428
Practice Address - Fax:954-438-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58551OtherDAVIS VISION
FLFL4213OtherEYEMED
FLPENDINGMedicaid
FLCE246AMedicare PIN