Provider Demographics
NPI:1760784102
Name:MIGLIORINO, CARLY ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ELIZABETH
Last Name:MIGLIORINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ELIZABETH
Other - Last Name:MIGLIORINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3157 WINGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5051
Mailing Address - Country:US
Mailing Address - Phone:813-253-9828
Mailing Address - Fax:
Practice Address - Street 1:2225 SUN VISTA DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:813-607-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4830152W00000X
FLOPC4625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist