Provider Demographics
NPI:1922381409
Name:CARCAMO, ADRIANA (OD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:CARCAMO
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 1:13852 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1304
Mailing Address - Country:US
Mailing Address - Phone:305-662-2990
Mailing Address - Fax:305-380-7106
Practice Address - Street 1:13852 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1304
Practice Address - Country:US
Practice Address - Phone:305-662-2990
Practice Address - Fax:305-380-7106
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004659200Medicaid
FLGX987ZMedicare PIN