Provider Demographics
NPI:1891489068
Name:CARLUCCI, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CARLUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2602
Mailing Address - Country:US
Mailing Address - Phone:732-922-8445
Mailing Address - Fax:732-918-8829
Practice Address - Street 1:3575 ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2602
Practice Address - Country:US
Practice Address - Phone:732-922-8445
Practice Address - Fax:732-918-8829
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician