Provider Demographics
NPI:1851373385
Name:CARBONI, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CARBONI
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 1:7419 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1167
Mailing Address - Country:US
Mailing Address - Phone:256-878-0125
Mailing Address - Fax:256-878-0898
Practice Address - Street 1:7419 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1167
Practice Address - Country:US
Practice Address - Phone:256-878-0125
Practice Address - Fax:256-878-0898
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS453TA283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051506834Medicaid
1053466821OtherORGINIZATIONAL NPI
AL1074080021Medicare NSC
AL051506834Medicaid
AL06834Medicare ID - Type Unspecified
AL06834Medicare PIN