Provider Demographics
NPI:1942372917
Name:PIZZARELLO, CARL P (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:P
Last Name:PIZZARELLO
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 1:183 NW MAGNOLIA LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3568
Mailing Address - Country:US
Mailing Address - Phone:772-343-1621
Mailing Address - Fax:772-873-9458
Practice Address - Street 1:1675 NW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2106
Practice Address - Country:US
Practice Address - Phone:772-785-8182
Practice Address - Fax:772-873-9458
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3568152W00000X, 152WC0802X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU85633Medicare UPIN
E5746ZMedicare ID - Type Unspecified