Provider Demographics
NPI:1245352913
Name:CARD, CAROL A
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:CARD
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 1:180 S KNOWLES AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7009
Mailing Address - Country:US
Mailing Address - Phone:407-644-1814
Mailing Address - Fax:
Practice Address - Street 1:180 S KNOWLES AVE
Practice Address - Street 2:STE 8
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7009
Practice Address - Country:US
Practice Address - Phone:407-644-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1075156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician