Provider Demographics
NPI:1619861101
Name:LUBO, CAITLYN ALEXIA (OD)
Entity type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:ALEXIA
Last Name:LUBO
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 1:9440 POINCIANA PL APT 106
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4819
Mailing Address - Country:US
Mailing Address - Phone:401-585-6168
Mailing Address - Fax:
Practice Address - Street 1:4413 LYONS RD STE 101
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4383
Practice Address - Country:US
Practice Address - Phone:954-975-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6678152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics