Provider Demographics
NPI:1730411943
Name:WENDY N CARBONE OD PA
Entity type:Organization
Organization Name:WENDY N CARBONE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES./ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-721-3009
Mailing Address - Street 1:6718 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4013
Mailing Address - Country:US
Mailing Address - Phone:954-721-3009
Mailing Address - Fax:954-722-0940
Practice Address - Street 1:6718 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4013
Practice Address - Country:US
Practice Address - Phone:954-721-3009
Practice Address - Fax:954-722-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS604AMedicare PIN