Provider Demographics
NPI:1700884103
Name:NASON, CAROL H (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:H
Last Name:NASON
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 1:7433 PRESCOTT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7849
Mailing Address - Country:US
Mailing Address - Phone:561-963-8148
Mailing Address - Fax:
Practice Address - Street 1:10550 W FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3135
Practice Address - Country:US
Practice Address - Phone:561-791-3937
Practice Address - Fax:561-333-8586
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620202000Medicaid
FL20716Medicare ID - Type Unspecified