Provider Demographics
NPI:1871362442
Name:CARMOLA, ADELAIDE
Entity type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:
Last Name:CARMOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10690 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3655
Mailing Address - Country:US
Mailing Address - Phone:904-646-4550
Mailing Address - Fax:904-645-0624
Practice Address - Street 1:10690 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3655
Practice Address - Country:US
Practice Address - Phone:904-646-4550
Practice Address - Fax:904-645-0624
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician