Provider Demographics
NPI:1679606503
Name:CARBONE, WENDY NADINE (OD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:NADINE
Last Name:CARBONE
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 1:10601 NW 5TH MNR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1643
Mailing Address - Country:US
Mailing Address - Phone:954-476-4659
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650568511OtherVCI
FLFL2615OtherEYEMED
FL20400OtherBCBS
FL650568511OtherVSP
FL3634OtherDAVIS VISION
FL3634OtherDAVIS VISION
FL650568511OtherVSP