# ISABEL M CARVAJAL OD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649409319
- **Authorized official:** ISABEL M CARVAJAL OD (PRESIDENT OPTOMETRIST)
- **Authorized official phone:** (954) 873-4130

## Contact information

- **Practice address:** 11605 PINES BLVD, PEMBROKE PINES, FL 33026-4109
- **Practice address phone:** (954) 438-2428
- **Practice address fax:** (954) 438-2450
- **Mailing address:** 5140 STAGECOACH DR, COCONUT CREEK, FL 33073-2242
- **Mailing address phone:** (954) 438-2428
- **Mailing address fax:** (954) 438-2429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC4213 | FL | Yes |

## Other

- **Enumeration date:** 07/02/2009
- **Last updated:** 08/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 58551 | DAVIS VISION | FL |
| 01 | — | FL4213 | EYEMED | FL |
| 05 | — | PENDING | — | FL |