Provider Demographics
NPI:1891025136
Name:GIGUERE, CAROL (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:GIGUERE
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 1:1480 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1713
Mailing Address - Country:US
Mailing Address - Phone:850-893-4005
Mailing Address - Fax:850-893-9987
Practice Address - Street 1:1480 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1713
Practice Address - Country:US
Practice Address - Phone:850-893-4687
Practice Address - Fax:850-893-4687
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2770152W00000X
TX04585T152W00000X
VA0618001209152W00000X
PR339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC2770OtherFL LICENSE
FL001859700Medicaid
FLOPC2770OtherFL LICENSE